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The risk of being declined for waitlisting due to psychosocial reasons was differentially higher in patients with Medicare insurance with ALD compared to private insurance and in women with ALD (Figure 1)

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Common biological features of chronic injury Microvascular limitation: the tissue is under-perfused, which slows nutrient delivery and waste removal Inflammatory persistence: cytokine signaling stays elevated and disrupts remodeling Disorganized collagen: collagen exists, but it is poorly aligned, weak, or prone to reinjury Mechanical mismatch: loads exceed tissue capacity due to weakness, compensation, or instability Neurogenic sensitivity: irritated tissues and nerves amplify pain signals even when imaging is normal In other words, chronic injuries do not usually need one intervention

13,28 In fact, the average time between seeking care and getting a fibromyalgia diagnosis has been reported to be 2.7 years