What Happens to Your Prescription When the Pain Gets Treated

If you are on opioid pain medication and you are coming to a pain clinic, the question underneath the appointment is usually the same one: are they going to take it away from me?

The honest answer is that the dose is not the thing being treated. What happens to your prescription depends on what happens to the pain, and those are two different clocks.

Why a taper on its own is not the plan

Reducing a dose is an intervention with its own risks, and they have been measured. In a study of 113,618 adults on stable higher-dose opioid therapy, periods after a taper carried 9.3 overdose or withdrawal events per 100 person-years compared with 5.5 in periods without one, and 7.6 mental health crisis events compared with 3.3. The faster the reduction, the higher both rates. A second analysis of the same population found the raised risk still present into the second year.

That is why nobody here is going to reduce your dose faster than you can tolerate, or leave you mid-taper without a plan. It is also why a taper is not treated as an achievement in itself. Our full position is on the opioid stewardship page.

The route that actually lowers the requirement

There is a second reason a dose comes down, and it is the one worth aiming at. Long-term opioid use can make the nervous system more sensitive to pain rather than less — a state called opioid-induced hyperalgesia. When that is happening, raising the dose buys a short improvement and then a worse baseline, and the pain often spreads beyond where it started. One review describes further opioid prescribing in that situation as largely futile.

The useful part is that this can run in reverse. Reviews of opioid tolerance and hyperalgesia note that interventional techniques which reduce the pain signal itself can permit the dose to come down and, in doing so, unwind the mechanisms that drove it up. Find the structure producing the pain, treat it directly, and the need for the medication falls on its own rather than being taken away from you.

That is what the diagnostic work at the front of your visit is for, and it is why medication management here sits alongside procedures rather than instead of them.

What that has looked like

On International Overdose Awareness Day in August 2026, Dr. Padda published the opioid figures from his interventional practice:

• New patients arrive on an average of more than 90 morphine milligram equivalents a day, after more than two and a half years in pain.
• Within 90 days of active interventional treatment, 21% are completely off opioid pain medication.
• Within one year, 34% are completely off all opioid pain medication.
• Of those who cannot be fully weaned, most are brought below 30 MME a day.

Those are practice-reported figures from that patient population, not trial outcomes, and individual results vary — yours will depend on what is causing your pain and what can be done about it. The release was carried by AP News; the full announcement is here.

What to expect at the first visit

• You will not be discharged for arriving on an opioid prescription. Most patients do.
• You will be asked to use one prescriber and one pharmacy, and the prescription monitoring program is checked for every patient, not as an accusation.
• The first work is diagnostic — establishing which structure is producing the pain before anything is treated.
• If a dose comes down, it comes down because something changed, at a rate you can tolerate, with a way back if it does not go well.

About Dr. Gurpreet Singh Padda, MD, MBA, MHP.

Sources

• Agnoli A, Xing G, Tancredi DJ, Magnan E, Jerant A, Fenton JJ. Association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids. JAMA. 2021;326(5):411–419. PMID 34342618 · DOI 10.1001/jama.2021.11013.
• Fenton JJ, Magnan E, Tseregounis IE, Xing G, Agnoli AL, Tancredi DJ. Long-term risk of overdose or mental health crisis after opioid dose tapering. JAMA Network Open. 2022;5(6):e2216726. PMID 35696163 · DOI 10.1001/jamanetworkopen.2022.16726.
• Mercadante S, Arcuri E, Santoni A. Opioid-induced tolerance and hyperalgesia. CNS Drugs. 2019;33(10):943–955. PMID 31578704 · DOI 10.1007/s40263-019-00660-0.
• Colvin LA, Bull F, Hales TG. Perioperative opioid analgesia — when is enough too much? A review of opioid-induced tolerance and hyperalgesia. The Lancet. 2019;393(10180):1558–1568. PMID 30983591 · DOI 10.1016/S0140-6736(19)30430-1.
• Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145–161. PMID 21412369.