Can you take opioids long term for chronic pain?

Harm reduction in the context of human frailty, not a gestapo policy that treats every milligram as a moral failure. Some pain comes from tissue that will never be fully repaired. Think of a nerve root scarred from surgery, a joint that has lost its cartilage, or a spine that has fused. For that kind of pain, leaving severe pain untreated has its own well-documented costs. It wrecks sleep. It isolates people from work and family. It does its own damage to the body through chronic stress signaling. A policy that chases zero opioids no matter what is actually wrong is not sobriety. It is abandonment wearing a compliance badge.

What are the alternatives to opioids for chronic pain?

The first alternative is removing the signal the opioid has been covering. A confirmed facet joint or nerve can be quieted for months with radiofrequency ablation, pain that outlasts ablation can be rerouted with spinal cord stimulation, and CRPS has ketamine, which works on a different receptor entirely.

Around those sits the work no pharmacy sells: sleep, graded movement and Acceptance and Commitment Therapy, which make up 40 to 50 percent of the plan here, plus bringing insulin and inflammation down so nerves stop firing so easily.

How far do opioid doses come down under care here?

Patients who arrive here after 2.5 or more years of unmanaged pain average more than 90 morphine milligram equivalents a day. That number reflects years of a system reaching for higher doses instead of a diagnosis. Under interventional treatment here, 21% are fully weaned within 90 days and 34% within a year. Among established patients, the ones further along in care, fewer than 1% remain above 90 MME. Practice-reported figures from our own population, not trial outcomes, and individual results vary. The gap between the number at arrival and the number later in care is the whole argument for this page.

How do injections and ablation lower an opioid dose?

An opioid dose is covering for something. Say a facet joint is the real source of a patient’s low back pain, and a medial branch block confirms it. Radiofrequency ablation can then remove a real share of that signal directly. That means the opioid dose that was covering it has less to cover. The dose comes down not because a taper schedule says so on a calendar, but because the input it was managing got smaller. That is the mechanical reason interventional care and opioid tapering are one conversation here, not two separate referrals. See radiofrequency ablation.

How do you taper opioids without withdrawal?

Withdrawal is not a symptom to power through. A taper that causes it usually gets dropped by the patient, not finished. The pace of a taper here is set by how fast the interventional and metabolic pieces are really shrinking the pain source. It is not set by a random percentage per month. That is also where the behavioral side of the practice matters. Sleep and dopaminergic drive are both thrown off during a taper. The in-house behavioral clinician helps manage that. It is not an afterthought. See sleep, movement and behavior.

Can opioids make pain worse?

Early in my career I treated raising the dose as the default answer to pain that was not responding. More milligrams for more pain, a straight line. The body does not actually run in a straight line. Opioids switch on glial cells (support cells in the nervous system) through toll-like receptor 4 signaling. That glial inflammatory response is a documented driver of opioid-induced hyperalgesia. In that state the drug itself lowers the threshold for pain, so raising the dose can make the underlying sensitivity worse, not better. That is a different problem from tolerance. Treating it with more of the same drug is fighting the fire with the thing that is feeding it.

That is why the practice separates two kinds of regimen. The first is a stable, low-dose regimen that restores function: a person who can work, sleep and move because of a steady, modest dose. The second keeps climbing, chasing a pain level that the climbing itself may be keeping alive. The first is a legitimate long-term plan for pain that cannot be reversed. The second gets a different conversation. Usually an interventional or metabolic option gets tried before the dose goes up again.

Who this practice is not for

This practice is not built around starting opioid therapy for pain that has not been worked up for a diagnosis. It is not a source for dose increases without an interventional or metabolic plan attached. If the goal walking in the door is a prescription with no diagnosis behind it, that is not what this page describes.

Frequently asked questions

Will you take me off opioids completely?

Not as a fixed policy. The target is the lowest dose that keeps you functioning and avoids withdrawal. For pain that truly cannot be reversed, that may not be zero. See what to expect for how that gets decided at the first visit.

How fast does a taper happen?

As fast as the pain source it is covering for really shrinks. That is usually tied to how quickly an interventional step like a medial branch block or ablation changes the underlying signal.

What is opioid-induced hyperalgesia?

It is a state where the opioid itself lowers your pain threshold instead of raising it, through glial inflammatory signaling. That is part of why diminishing returns on a treatment sometimes mean the treatment needs to change, not increase.

Is prior authorization the same as coverage being approved?

No — an authorization is permission to proceed, not a guarantee of payment, and that distinction matters when planning an interventional step alongside a taper. Contact us with specific coverage questions before a procedure is scheduled.

What is opioid stewardship?

Opioid stewardship is a framework for the smallest opioid exposure that keeps you functioning and prevents withdrawal. It is not a blanket ban on opioids. It is not permission to keep raising them, either. Here it is built around interventional care, because treating the structure that generates the pain lowers what any dose has to cover. For irreversible pain, the lowest dose that works may not be zero.

Do you start new patients on opioids?

This practice is not built around starting opioid therapy for pain that has not been worked up for a diagnosis. It is not a source for dose increases without an interventional or metabolic plan attached. If you already take opioids, bring your current medication list and your history. The first conversation is about what the medication has been standing in for, and how to find and treat it.

Why not just raise the dose when the pain gets worse?

Because the dose itself can become the problem. Opioids switch on glial cells through toll-like receptor 4 signaling, which can lower the pain threshold, so raising the dose may make the underlying sensitivity worse. A stable, low-dose regimen that keeps someone working, sleeping and moving is a legitimate long-term plan. An escalating one gets a different conversation, and usually an interventional or metabolic alternative is tried first.

Related reading

• About Dr. Padda
• Radiofrequency ablation
• Sleep, movement and behavior
• When injections stop working
• What to expect at the first visit