Treatment Approach
Our approach focuses on finding a sustainable opioid balance that supports real life, not endurance or ideology.
Long-term prescribed opioid treatment can drift into doses that reduce function, blunt motivation, and increase pain sensitivity over time. Careful tapering often improves clarity, mobility, mood, and daily engagement. Less medication can mean more life.
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At the same time, pain does not disappear simply because medication is reduced. Physical pain, emotional pain, and trauma-related pain remain real and can resurface after months or even years. Pushing pain aside entirely often leads to isolation, loss of function, and eventual destabilization.
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Our work is about calibration, not extremes.
Not more medication.
Not zero medication.
But the lowest effective level that allows movement, connection, exercise, and participation in life.
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We support people through adjustment, overcorrection, setbacks, and reassessment without judgment. Progress is not linear, and decisions are revisited as life changes. The goal is not perfection. The goal is a life that is livable, active, and sustainable.
In my own words:
A treatment plan needs to be better than just stop taking opioids. I must explain that a taper will help a client cut back to a level that is better for them. I need to state without saying: "less opioids are better then more, opioid overuse can cause pathways to become more susceptible to smaller pain impulses and the opioid itself can cause pain in ways we only vaguely understand. Less is better, to a point."
My goal is to get a client to live better, do more, get more exercise, get more life all while having some level of pain. That cannot happen when they are overmedicated all the time, even if they are at the lowest level of overmedication.
The trick is finding a balance. The lowest level of medication and the lowest level of pain at the highest level of activity and interactivity.
Our biggest problem is that usually a client will overcompensate and end up taking NO OPIOIDS because it feels better taking less only to find that the chronic pain still exists and is still bad enough to affect their life negatively. That is when shame comes up and pride takes over. The negativity and stigma of opioid use kicks on and causes the client to PUSH back from taking any opioids.
Taking nothing for pain may work for a month or even a year, but eventually they MUST turn back to pain relief meds even if that pain is emotional from loss or worse from PTSD.
Anyone that has quit opioids will eventually go back because they know deep down there is NO NEED to suffer!
Getting our client to see this is the most difficult part of our job. Finding a balance is hard, finding a balance so the client is accepting they are only human and too much pain will eventually destroy their lives just as much as too many opioids!
I need to have the ability to see their lives compassionately and their discissions rationally yet still be there for them when they make mistakes.
Gerald Kichok