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Updated September 4, 2026
My article, published in HealthCentral (formerly Practical Pain Management), “We Have a Chronic Pain Problem, Not a Prescription Opioid Problem,” explored the benefits and risks of opioid therapy for chronic pain and the need for greater access to pain rehabilitation programs. Below is some of the original content I submitted that didn't make it into the published version. It provides additional context and explains how my own experience shaped my thinking about opioid therapy. The rise of prescription opioids Beginning in the 1990s, opioid prescribing for chronic noncancer pain increased substantially in the United States. Several factors contributed to this increase, including:
As opioid prescribing increased, so did opioid-related harms, including opioid use disorder and overdose deaths. The response eventually shifted toward reducing opioid prescribing and increasing awareness of the risks associated with long-term opioid therapy. That response was necessary. But some of the policies and practices that followed also created problems for people who were already taking opioids for chronic pain. What happened to patients taking opioids? Following the release of the CDC's 2016 opioid prescribing guideline, some patients experienced rapid or involuntary reductions in opioid doses, abrupt discontinuation, loss of access to prescribers, or inadequate support during tapering. Some people also struggled to find alternative treatments or access comprehensive pain rehabilitation. These experiences created fear and mistrust among many people living with chronic pain. It's important to distinguish those experiences from what the current CDC guideline actually recommends. The 2022 guideline specifically warns against abrupt discontinuation and rapid tapering and emphasizes individualized, patient-centered decisions. Rapid or abrupt discontinuation can cause withdrawal, worsening pain, psychological distress, and other serious problems. The FDA has also warned about harms associated with sudden discontinuation or rapid dose reductions in physically dependent patients. We need to learn from those experiences. Reducing inappropriate opioid use is important. But protecting patients from the harms of inappropriate tapering is important, too. Opioid therapy is not the same as addiction One thing that often gets lost in discussions about opioids is the distinction between physical dependence and opioid use disorder. A person who takes opioids regularly can develop physical dependence. That means the body has adapted to the medication, and suddenly stopping it can produce withdrawal symptoms. Physical dependence does not automatically mean that someone has an opioid use disorder. Someone can legitimately need help tapering from a medication without being addicted to it. That's one reason opioid treatment and opioid tapering need to be handled carefully and without judgment. Opioid therapy is a shared decision There isn't a crystal ball when it comes to pain treatment. There's no way to know with certainty how an individual person will respond to a particular treatment. For some people, opioid therapy may provide meaningful benefits that outweigh its risks. For others, the benefits may be limited, may diminish over time, or may not justify the risks. The decision should be individualized and made collaboratively by the patient and healthcare professional. Current CDC guidance recommends carefully weighing the benefits and risks of continuing opioid therapy. When benefits outweigh risks, clinicians should work with patients to optimize nonopioid therapies while continuing opioid therapy. When risks outweigh benefits, clinicians should work with patients to gradually reduce the dosage or discontinue opioids when appropriate. The goal shouldn't be to force everyone onto opioids or to force everyone off them. The goal should be appropriate, individualized care. What does the research show? A 2024 systematic review and meta-analysis examined 35 randomized controlled trials evaluating opioid therapy and quality of life in people with chronic noncancer pain. The researchers found statistically significant improvements in some physical measures of quality of life compared with placebo, but the effects were small and judged to be unlikely to be clinically important. They found no significant improvement in mental quality of life. The authors also noted that the evidence was low to medium quality and that the studies primarily examined the initial months of treatment. This doesn't mean opioids never help. It means we shouldn't assume that long-term opioid therapy will broadly restore quality of life for people living with chronic pain. Pain treatment needs to be about more than pain intensity. Function, activity, sleep, mood, relationships, quality of life, and the ability to participate in meaningful activities matter, too. Tapering can be difficult If a decision is made to reduce or discontinue long-term opioid therapy, tapering needs to be approached carefully. People may be afraid of increased pain, withdrawal symptoms, loss of function, or simply not knowing what will happen when their medication is reduced. Those concerns deserve to be taken seriously. The current CDC guideline recommends that tapering be individualized and developed collaboratively with the patient. It specifically advises against abrupt discontinuation and rapid dose reductions except in situations involving serious immediate safety concerns. Tapers may need to take months or longer, particularly after long-term opioid use. Patients need to understand that pain or other symptoms may temporarily worsen during a taper. Providers also need to understand that tapering isn't simply a matter of reducing a number on a prescription. The whole person needs to be supported. That means addressing pain, withdrawal symptoms, emotional distress, function, sleep, and access to appropriate nonopioid and nonpharmacologic treatments. Transitioning to self-management takes time One of the most important lessons I learned is that transitioning from reliance on treatment toward greater self-management doesn't happen overnight. It's a marathon, not a sprint. Pain rehabilitation can help people develop the knowledge, skills, confidence, and strategies they need to take a more active role in managing chronic pain. That doesn't mean refusing medication. It doesn't mean refusing medical care. And it doesn't mean that everyone needs to stop taking opioids. It means making self-management part of the overall treatment plan rather than relying on medical treatment to do everything for us. My experience My chronic pain recovery began when I accepted that pain was part of my life and stopped constantly searching for another doctor, procedure, or treatment that might finally make the pain disappear. Many thanks to the Mayo Clinic Pain Rehabilitation Center. Through pain rehabilitation, I learned how to self-manage my chronic pain and focus more on living my life than on constantly trying to eliminate the pain. As part of that process, I was able to taper off opioids — eventually stop other medications, including benzodiazepines, anticonvulsants, muscle relaxers, amphetamines, beta-blockers, antidepressants, and over-the-counter analgesics. I also moved away from other treatments that had become part of my previous approach to managing pain. That was my experience. I'm not suggesting that everyone with chronic pain should stop taking medication or follow the same path I did. What worked for me may not be appropriate for someone else. What I do believe is that people living with chronic pain should have the opportunity to learn active self-management skills and to participate meaningfully in decisions about their treatment. The bottom line Opioids are neither a miracle cure nor something that should automatically be dismissed. They can provide meaningful pain relief for some people, but they also carry important risks, particularly with long-term use. The answer isn't simply to prescribe more opioids. And it isn't simply to take them away. We need individualized, patient-centered care that considers both the benefits and risks of opioid therapy while also helping people develop active strategies for managing chronic pain. For some people, that may include continuing opioid therapy. For others, it may mean gradually reducing or discontinuing opioids. Either way, people shouldn't be abandoned. They should be supported. And they should have access to comprehensive pain care, including pain rehabilitation and self-management strategies when appropriate. For me, learning to actively manage chronic pain was a turning point. I stopped looking for someone to fix me and started learning how to live my life. That's the approach I believe deserves a bigger place in chronic pain care. Learn more
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