Dying for Some Sleep

Michael Jackson was the King of Pop, famous worldwide for his performances and iconic moonwalk. During a Pepsi commercial shoot in 1984, pyrotechnics ignited his hair, leaving him severely burned and traumatized. In the years that followed, he suffered from widespread pain, severe insomnia, and constant fatigue. He sought care, but instead received an escalating regimen of risky drugs. His 2009 death from a combination of benzodiazepines and propofol was ruled a homicide, and his physician was convicted of involuntary manslaughter.

At the time, Jackson’s health struggles were written off as mysterious or eccentric. In clinical terms today, his battle with nonrestorative sleep, chronic pain, and fatigue would hopefully be recognized as fibromyalgia—a complex, invisible condition that eludes labs or imaging. I say “hopefully” because more than 15 years after his death, fibromyalgia and other chronic pain syndromes are still overlooked when clinicians fall into the trap of chasing individual symptoms with powerful medications—typically benzodiazepines for sleep and opioids for pain.

Gender assumptions further complicate care. Although fibromyalgia is diagnosed disproportionately in women—80 to 90% of cases—some studies suggest men may account for up to 40%. But until 2016, diagnostic criteria required tender points typical of fibromyalgia in women but uncommon in men. If Jackson were alive today, there’s a chance he might be accurately diagnosed; yet only a chance. The same patient profiling that failed him is still too prevalent.

Medical science now makes it clear that chronic conditions like fibromyalgia are marked by a reinforcing cycle of nonrestorative sleep and persistent pain. Poor sleep amplifies pain sensitivity, and pain in turn further disrupts sleep, locking patients into a debilitating feedback loop. Yet too many clinicians still treat symptoms in isolation—prescribing opioids and other addictive drugs with no established benefit—rather than the constellation of factors that define chronic pain conditions.

There are signs of progress. Regulators have begun to recognize that chronic pain cannot be addressed with acute-care models alone. The FDA issued 2025 draft guidance to streamline development pathways for non-opioid analgesics for chronic pain, signaling a shift toward treatments that reflect patients’ lived experience. At the same time, recent research documented how trauma and post-traumatic stress may contribute to the onset or worsening of chronic pain syndromes.

But medical training has been slow to integrate modern pain science, particularly the central role of sleep disruption and the limits of imaging-driven diagnosis. The result is a system where knowledge has deepened but medical practice hasn’t caught up, with patients left to endure damaging patterns of pain and disrupted sleep. This unacceptable reality demands change.

Addressing the harmful disconnect between science and care requires coordinated action across regulation, research, medical education, and everyday clinical practice. That work should begin with full implementation of the FDA’s 2025 non-opioid analgesic guidance, paired with incentives that support innovation, adoption in clinical settings, and access.

ARPA-H can drive a paradigm shift by directing its high-risk, high-reward expertise toward next-generation treatment for chronic pain conditions like fibromyalgia. The National Institutes of Health can fast-track nonaddictive drug research through its HEAL Initiative. The CDC can advance chronic pain surveillance to capture gender disparities. The Centers for Medicare & Medicaid Services can ensure effective pain care by covering what improves health, not what’s easiest to prescribe. And medical education and standards must evolve to reflect pain science, equipping doctors to treat patients holistically rather than one symptom at a time.

Imagine if Michael Jackson had been diagnosed with fibromyalgia and received nonaddictive medicine instead of dangerous drugs that proved lethal. We know better now. While his genius was rare, his medical story and the so-called care that followed are not. Guided by science, we can better target relentless cycles of bad sleep and even worse pain. No one should be left dying for sleep because medicine failed them.