For years, opioids were considered the gold standard for chronic pain. Many patients were started on these medications with the hope that higher doses would lead to better relief and improved function. But for a large percentage of people, long-term opioid therapy doesn’t work the way they expected—and in many cases, it may actually make pain and daily functioning worse.

If you’ve ever wondered whether opioids are truly helping your pain—or if it’s time to re-evaluate your treatment plan—you’re not alone. At Monarch Medical, we help hundreds of patients navigate this question safely, compassionately, and without judgment. Here’s how to know whether your current opioid plan is moving you forward or holding you back.

1. The Opioid Plateau: Why Pain Relief Often Fades Over Time

Opioids can be very effective for acute pain, post-surgical recovery, and cancer-related pain.
But for chronic, long-standing pain, the story is different.

Over time, the body adapts to opioids through tolerance, meaning you need more of the medication to get the same effect. Eventually, many patients reach a point where:

• The medication doesn’t last as long

• Relief isn’t as strong

• Pain returns quickly after each dose

• Increasing the dosage no longer improves function

Even worse, long-term opioid use can contribute to opioid-induced hyperalgesia, a condition where the nervous system becomes more sensitive to pain. The result? The medication you rely on may actually make your pain worse.

2. Signs Your Opioid Medication May No Longer Be Helping

You may benefit from re-evaluating opioid therapy if you notice any of the following:

✔ Your pain is the same or worse despite dose increases

This is one of the clearest signs of tolerance and diminished benefit.

✔ You’re able to do less in your daily life

The goal of pain treatment is to improve function, not just reduce pain scores.

✔ Your medication wears off quickly or causes withdrawal symptoms between doses

This is a sign that your body is depending on the medication rather than benefiting from it.

✔ You’re experiencing more side effects than relief

Common long-term side effects include:

• Constipation

• Fatigue or sedation

• Mood swings or depression

• Brain fog or difficulty concentrating

• Hormone disruption

✔ You find yourself thinking about your next dose

This doesn’t mean you’re addicted—it means the medication may not be serving you anymore.

3. The Hidden Risks of Staying on Chronic Opioids

Contrary to popular belief, long-term opioid therapy is not risk-free, even when taken exactly as prescribed.

Physical Risks

• Respiratory depression

• Increased fall risk

• Hormonal suppression (especially testosterone)

• Constipation and GI issues

• Weight gain or worsening sleep apnea

Neurological & Emotional Risks

• Depression and anxiety

• Impaired concentration

• Hyperalgesia (heightened pain sensitivity)

Functional Risks

• Reduced motivation

• Decreased physical activity

• Less engagement in other pain treatments that may be more effective

The longer someone stays on opioids without meaningful benefit, the more these risks accumulate.

4. There Are Safer, More Effective Options for Chronic Pain

Many patients assume opioids are their only option—but modern pain management has evolved dramatically. For most chronic pain conditions, non-opioid therapies outperform opioids in long-term outcomes.

Here are evidence-supported alternatives:

Medications

• Duloxetine – excellent for neuropathic pain, back pain, fibromyalgia

• Pregabalin / Gabapentin – nerve and radicular pain

• Jornavix-type non-opioid analgesics – new options that target both nociceptive and neuropathic pain

• NSAIDs or topical agents for localized pain

Injection Therapy

• Joint injections

• Trigger point injections

• Epidural or facet injections

• Hyaluronic acid knee injections

Lifestyle Interventions

• Weight loss (even 5–10% reduction dramatically improves joint and back pain)

• Anti-inflammatory nutrition

• Sleep optimization

Physical & Functional Care

• Targeted physical therapy

• Strengthening and mobility programs

• Aquatic therapy

• TENS, red light therapy, heat, and ice

Mental Health Integration

Pain and mood are tightly connected. Treating depression, anxiety, PTSD, or stress can significantly improve chronic pain.

5. When to Discuss Re-Evaluating Opioids

You don’t need to be in crisis to talk about modifying your opioid plan. Ideal times to re-evaluate include:

• You don’t feel meaningfully better than before starting opioids

• Your dose has gone up but your pain hasn’t improved

• You’re having increasing side effects

• You want to explore safer or more effective options

• You’re preparing for surgery or major lifestyle change

• You’re curious about tapering but don’t know where to start

Re-evaluation does not mean stopping cold turkey or suffering through withdrawal. A thoughtful plan, at your pace, is always the goal.

6. Tapering and Opioid Reduction: What It Actually Looks Like

Many patients fear tapering because they imagine sudden withdrawal or uncontrolled pain.
In reality, a safe taper should be:

• Slow

• Collaborative

• Adjustable

• Designed to maintain or improve pain control

Most tapers include:

• Small dose reductions every 1–4 weeks

• Non-opioid medications added to support pain control

• Sleep and mood support

• Regular check-ins with your provider

• The option to pause if needed

Many patients actually feel better after reducing opioids due to:

• More stable mood

• Less fatigue

• Clearer thinking

• Reduced hyperalgesia

7. You Deserve a Pain Plan That Truly Works

If opioids are helping you—meaning you have better pain control, improved function, minimal side effects, and stable dosing—then continued use may be appropriate.

But if opioids are not giving you the quality of life you deserve, it may be time to explore options that can provide:

• Better pain relief

• Improved mobility

• Better mood

• Lower health risks

• Greater long-term safety

At Monarch Medical, we work with you—not against you—to find the safest and most effective treatment plan for your chronic pain.

Ready to Talk About Whether Opioids Are Still Helping You?

There is no judgment and no pressure—just a conversation about what is working, what isn’t, and what your goals are. Your pain story is unique. Your treatment plan should be too.