What to know about chronic pain after CEO shooting suspect Luigi Mangione appeared to detail health struggles

Authorities are looking into online accounts believed to be those of Luigi Mangione, the 26-year-old Ivy League graduate charged with murder in the fatal shooting of UnitedHealthcare CEO Brian Thompson on a Manhattan street, that have posted about health struggles and possible medical successes.

Mangione appeared to operate a Reddit profile where he detailed health issues including back pain, brain fog and sciatica. The account made several posts on a subreddit dedicated to spondylolisthesis -- a condition where a vertebra slips out of alignment. Mangione also might have planned to read or already read multiple books on back pain based on a Goodreads account associated with him.

Law enforcement sources have told ABC News that the Reddit profile -- which has since been taken down -- is being reviewed for additional details about the extent of the injuries mentioned. A Reddit spokesperson told ABC News regarding the page that their policy is to suspend accounts that may potentially be related to suspects in high-profile criminal investigations.

Mangione is accused of gunning down Thompson outside a Midtown Manhattan hotel on Dec. 4. Written on the shell casings were the words "deny," "defend" and "depose," according to police sources. Mangione was apprehended in Altoona, Pennsylvania, on Monday after nearly one week on the run. He allegedly had a spiral notebook detailing plans about how to eventually kill the CEO, according to law enforcement officials.

Mangione is being held without bail in Pennsylvania, where he faces charges including allegedly possessing an untraceable ghost gun. Defense attorney Thomas Dickey told reporters on Tuesday that Mangione will plead not guilty to the Pennsylvania charges. He said he anticipates that Mangione will also plead not guilty to the second-degree murder charge in New York.

The posts and reading lists paint a picture of someone seeking answers, sharing how spinal fusion surgery brought the author relief after years of discomfort.

"Chronic pain can be incredibly debilitating. It can affect every aspect of your life," Dr. Joseph Shrand, chief medical officer of Riverside Community Care in Massachusetts and a Harvard Medical School faculty member, told ABC News.

While the Reddit posts suggest a spinal surgery was a significant moment in his life, the author of the posts said the procedure left him pain-free, and he frequently encouraged others to undertake similar procedures.

In an August 2023 post, the user remarked how his spinal injury was once "completely devastating" and worried he was "destined to chronic pain and a desk job for the rest of my life" before considering surgery.

Chronic pain, defined as pain lasting three months or more, affects about 50 million U.S. adults, according to the National Institutes of Health. Of these, 17 million Americans experience "high impact" chronic pain, which is so debilitating that it disrupts daily activities like work, self-care and relationships, the NIH says.

Women, older adults, and those living in poverty or rural areas tend to report the highest rates of persistent pain. So do people who are divorced or separated, identify as bisexual, or say they are generally in poor health, according to the NIH.

Studies suggest that chronic pain can put people at a higher risk of mental health struggles, as well as create a financial burden.

Research shows that between 35% to 45% of those with chronic pain experience depression, while anxiety disorders are similarly common. Pain may interfere with sleep, increase stress, and create cycles of declining mental and physical health.

"Chronic pain puts you at a disadvantage mentally because you may think other people see you as broken," Shrand said. "There will be times where you may feel in such physical pain that it becomes emotional pain, too."

Some studies suggest a biological link between chronic pain and mental health disorders. For example, depression can heighten pain sensitivity, reinforcing the connection between the two, according to a study in the journal Neural Plasticity.

Chronic pain affects every facet of life. It can limit employment opportunities, disrupt social connections and lead to cognitive challenges, including "brain fog."

"People have difficulty getting out of bed in the morning because their backs hurt, which means that they're potentially at risk of coming into work late, which then puts them at risk for the cascade effects of all those things that can happen because they are now perceived as a person who isn't doing their job right," Shrand said.

Chronic pain can lead to a substantial financial burden, as well. According to one  Journal of Pain study, individuals with severe pain spend more than $4,000 more annually on health care versus those without pain.

Managing chronic pain requires a combination of medical, psychological and lifestyle interventions, but insurance often prioritizes medications and procedures with inconsistent results.

For instance, lumbar fusion surgeries -- such as the one purportedly described by Mangione -- are commonly performed but often fail to provide lasting relief, according to various studies.

When Mangione was arrested on Monday, he had "written admissions about the crime" with him, according to the New York arrest warrant.

Mangione had several handwritten pages on him that expressed a "disdain for corporate America" and indicated "he's frustrated with the health care system in the United States," NYPD Chief of Detectives Joe Kenny told ABC News' "Good Morning America" on Tuesday.

The words on the bullets echo the title of the 2010 book "Delay, Deny, Defend: Why Insurance Companies Don't Pay Claims and What You Can Do About It." Police are aware of the similarity, and are investigating whether one possible motive is anger at the insurance industry, sources said.

While the Reddit posts suggest a spinal surgery was a significant moment in his life, the author of the posts said the procedure left him pain-free, and he frequently encouraged others to undertake similar procedures.

One of Mangione's apparent posts on the r/Spondylolisthesis subreddit in February 2024 referred to having had a surgery for the condition six months prior. The author said that "[w]within 7 days of the fusion I was on zero pain meds."

Many widely used approaches, such as opioids or steroid injections, provide only temporary solutions to chronic pain. Meanwhile, treatments like cognitive behavioral therapy, yoga and acceptance therapy show promise but remain difficult to access due to cost and insurance coverage gaps.

However, many chronic pain patients face a maze of treatments that don't fully address their needs or the root causes of their pain.

Shrand said the best approach often requires a combination of solutions.

"You can't just attack the physical. You've got to address the biological, mental and social aspects of life," he said. "You can manage this pain -- it's part of your body, and we can find a way to take care of you."

ABC News' Peter Charalambous, Aaron Katersky, Kerem Inal, Chris Looft and Sasha Pezenik contributed to this report.