Opioid stewardship here means we find and treat what is generating the pain, and the opioid dose comes down as that pain comes under control. We will not just keep signing a high-dose script. And nobody is turned away for showing up on one.
We are an interventional pain practice, not an opioid practice. The difference matters, so here it is in plain terms.
What we will not do
We will not take over a high-dose opioid script and just keep signing it. We will not raise a dose because the last raise stopped working. We will not treat rising tolerance as if it were rising disease.
If that is what you want, we tell you now. Better now than after you take time off work to see us.
What replaces opioids for chronic pain?
We find out what is causing the pain and treat that head-on. For most patients that means image-guided injections, nerve blocks, radiofrequency ablation and physical therapy. It also means work on the things that keep the nervous system on high alert: sleep, blood sugar, inflammation and loss of fitness.
As the pain source comes under control, the opioid dose comes down. That order matters. Tapering someone whose pain has not been treated is not stewardship. It is abandonment with better paperwork.
Will a pain clinic see me if I am already on opioids?
Most patients who come to us are, and nobody is turned away for it. Coming in on an opioid script is the normal starting point. It is not a mark against you.
- You will not be sent away at the first visit for being on an opioid.
- You will not be tapered faster than you can tolerate.
- You will not be left mid-taper without a plan.
- You will be asked to use one prescriber and one pharmacy. We will check the prescription monitoring program (the state database of filled scripts). We do that for every patient. It is not an accusation.
What does tapering off opioids feel like?
It is harder than the pamphlets suggest. Coming down off a long-held dose usually takes months, not weeks. There are stretches where pain and sleep get worse before they get better. You deserve to hear that at the first visit, not find it out at the fourth.
What makes it work is that the taper runs alongside real treatment, not in place of it. Once the source of the pain has been treated, each step down costs less than the one before.
Why we take this seriously
Missouri has spent two decades paying for treating chronic pain mainly with opioids. The people who paid were patients who did what they were told. We will not repeat that. We will not swing too far the other way, either, and leave people in pain to keep a prescribing average tidy.
How many patients get off opioids completely?
The interventional practice of Dr. Gurpreet Singh Padda, MD, MBA, MHP, published its own opioid figures on International Overdose Awareness Day, August 31, 2026. The average new patient arrives after more than two and a half years in pain. They are on more than 90 morphine milligram equivalents a day. Within 90 days of active interventional treatment, 21% are fully off opioid pain drugs. Within one year, 34% are. Of those who cannot be fully weaned, the large majority are brought below 30 MME per day. These are figures the practice reported from its own patients, not trial results, and individual results vary.
That is the same rule described above: the taper works because it runs alongside treatment of the pain source, not in place of it. The release was carried by AP News and the Columbia Daily Tribune; the full announcement is here.
Frequently asked questions
How long does it take to taper off opioids?
Usually months, not weeks. There are stretches where pain and sleep get worse before they get better. We tell you that at the first visit, not the fourth. The taper runs at a pace your body can handle. It runs alongside treatment of the pain source, so each step down costs less than the one before.
Will I be discharged for being on opioids?
No. Most patients who come to us are already on an opioid. Nobody is turned away or sent away at the first visit for it. Arriving on a script is the normal starting point, not a mark against you. You will not be tapered faster than you can tolerate. You will not be left mid-taper without a plan.
Will you just refill my current opioid prescription?
No. We will not take over a high-dose script and just keep signing it. We will not raise a dose because the last raise stopped working. We find what is causing the pain. Then we treat it with image-guided injections, nerve blocks, radiofrequency ablation and physical therapy. As that pain comes under control, the dose comes down.
Do I have to use one prescriber and one pharmacy?
Yes. Every patient is asked to use one prescriber and one pharmacy. We check the prescription monitoring program for every patient. It is the same rule for everyone, and it is not an accusation. It sits alongside real treatment of the pain. That is what lets the dose come down safely.
Sources
- Dowell D et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR Recommendations and Reports, 2022. PubMed 36327391
- Agnoli A et al. Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids. JAMA, 2021. PubMed 34342618
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