Opioid therapy may be considered for selected patients with severe pain when benefits, risks, function, safety, and alternatives are carefully reviewed.
Opioids can play an important role in certain situations, but they're not the right solution for most chronic pain. Dr. Siefferman explains when opioid therapy may be appropriate and how it fits into a comprehensive pain management plan.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine. Opioids, as you may know, have been overused chronically for chronic pain. And we know now that opioids long-term are not good for the body in general and specifically not good for chronic pain. Is there a use purpose for opioids? Absolutely.
If you’ve had a recent surgery, if there’s a new pain that we expect to resolve in a short term, opioids are appropriate. If you have a terminal illness, opioids may be appropriate. But for otherwise chronic pain that has no end date, opioids are generally not considered appropriate therapy.
Opioid therapy is a controlled medication strategy that may be considered for selected patients with severe, persistent, cancer-related, or complex chronic pain when other options have not provided enough relief or are not appropriate. It is not a default treatment, a refill service, or the right choice for every patient.
At Manhattan Pain Medicine, opioid therapy for chronic pain NYC care begins with diagnosis-first evaluation, risk-benefit review, functional goal setting, medication reconciliation, side effect assessment, and consideration of non-opioid alternatives. When opioids are considered, MPM uses careful monitoring and coordinated care to support safety.
MPM specialists evaluate whether opioid therapy may be appropriate by first understanding the diagnosis, pain severity, prior treatment response, functional limitations, medication history, side effects, and risk factors.
Opioids may be considered differently in cancer pain, severe complex chronic pain, abdominal pain, pelvic pain, autoimmune-related pain, or post-surgical pain. The team also reviews constipation risk, sedation, mood effects, sleep apnea risk, medication interactions, dependence concerns, overdose risk, and whether non-opioid medications, procedures, pain psychology, infusions, rehabilitation, buprenorphine, or Suboxone may be safer or more appropriate.
Patients seeking opioid pain management in NYC often have a complicated history. Some have severe pain that has not improved with non-opioid medications, injections, physical therapy, surgery, pain psychology, pelvic pain care, GI care, oncology care, or other specialist treatment. Others are already taking opioids and need safer oversight, a second opinion, or help understanding whether the medication is still supporting function.
MPM approaches opioid therapy with careful structure. This may include prescription monitoring, medication reconciliation, urine drug testing, controlled substance agreements, naloxone discussion, bowel regimen planning, functional goal review, and coordination with other clinicians. The goal is not to judge patients or dismiss pain. The goal is to determine whether opioid therapy is clinically appropriate, whether benefits outweigh risks, and whether the treatment is helping the patient move toward safer, more functional care.
Opioid therapy may intersect with several MPM Zones of Expertise, including Complex Chronic Pain, Autoimmune and Inflammatory pain, Psychology of Pain, Musculoskeletal issues, and Pelvic Pain. For complex chronic pain, opioid decisions require careful review of function, central sensitization, prior treatments, and long-term safety. For autoimmune and inflammatory pain, medication planning may need coordination with rheumatology, anti-inflammatory strategies, DMARDs, biologics, or other disease-directed care.
For pelvic, abdominal, endometriosis-related, or cancer-related pain, opioid therapy may be considered only within a broader diagnostic and safety framework. Psychology of Pain is also relevant because long-term pain and opioid therapy can affect mood, fear, coping, sleep, function, and stigma. MPM uses nonjudgmental communication while maintaining clear safety standards.
During an opioid therapy evaluation, MPM reviews the patient’s diagnosis, pain history, current medications, prior opioid and non-opioid medication trials, side effects, functional goals, pharmacy history, and safety risks. Patients should be prepared to discuss what has helped, what has not helped, whether opioids are improving function, and whether side effects such as constipation, sedation, nausea, mood changes, sleep disruption, or withdrawal symptoms are present.
If opioid therapy is considered, MPM may use prescription monitoring, urine drug testing, controlled substance agreements, naloxone discussion, bowel regimen planning, medication interaction review, and coordination with other clinicians. If risks outweigh benefits, MPM may discuss tapering, medication changes, buprenorphine or Suboxone options for selected patients, non-opioid strategies, pain psychology, procedures, infusions, or other coordinated care options.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Opioid therapy is the use of opioid medications as part of a medically supervised pain management plan. Opioids may be considered for selected patients with severe, persistent, cancer-related, or complex chronic pain when benefits may outweigh risks and other options have not provided enough relief or are not appropriate. Opioid therapy is not a cure and is not the right treatment for every pain condition. At MPM, it requires diagnosis-first evaluation, functional goals, safety monitoring, and regular reassessment.
Opioids may be considered only after careful review of the diagnosis, pain severity, prior treatments, non-opioid options, function, safety risks, and patient goals. They are not first-line for many chronic pain conditions. MPM evaluates whether the pain type is likely to respond, whether safer options exist, and whether opioid therapy would support meaningful function. If the risks outweigh potential benefits, other options such as non-opioid medication, procedures, infusions, pain psychology, rehabilitation, or buprenorphine-based care may be considered.
MPM evaluates opioid therapy for selected patients, but opioids are not prescribed automatically and existing opioid regimens are not continued without review. The decision depends on diagnosis, prior treatment history, current medications, functional goals, safety risks, monitoring requirements, and whether benefits are likely to outweigh harms. MPM does not function as an opioid refill clinic. If opioid therapy is not appropriate, the care plan may focus on safer medication options, procedures, pain psychology, infusions, or specialist coordination.
Opioids may be appropriate for some patients with cancer-related pain, depending on diagnosis, pain severity, stage of care, oncology plan, prior treatments, function, and safety factors. Cancer pain often requires coordination with oncology, palliative care, primary care, and other treating clinicians. MPM evaluates opioid therapy within that broader medical context. Even when opioids are appropriate, side effects such as constipation, sedation, nausea, medication interactions, and overdose risk still require careful monitoring.
Opioids are not automatically appropriate for pelvic pain or abdominal pain. These symptoms may involve endometriosis, pelvic floor dysfunction, nerve pain, gastrointestinal conditions, urinary conditions, inflammation, hernia-related pain, gastroparesis, constipation, or other causes. Opioids can worsen constipation, nausea, abdominal pain, and bowel motility problems in some patients. MPM evaluates the pain source and GI risk before considering opioid therapy and may recommend pelvic specialty care, GI care, non-opioid medications, procedures, or pain psychology instead.
Yes. Opioids can slow the gastrointestinal system and may worsen constipation, nausea, bloating, abdominal discomfort, or symptoms related to gastroparesis. Patients with chronic constipation, abdominal pain, stomach pain, or gastroparesis need careful review before opioid therapy is considered. If opioids are used, bowel regimen planning and monitoring may be necessary. MPM evaluates GI symptoms, current medications, diet, hydration, mobility, and other risk factors to reduce harm when possible.
Long-term opioid therapy can involve tolerance, physical dependence, constipation, sedation, mental fog, nausea, hormonal changes, mood changes, sleep disruption, slowed breathing, overdose, medication interactions, opioid use disorder, and opioid-induced hyperalgesia. Risks increase when opioids are combined with sedatives, alcohol, certain sleep medications, or other medications that affect breathing or alertness. MPM uses careful risk-benefit review, functional goals, monitoring, and reassessment before continuing or starting long-term opioid therapy.
Monitoring may include medication reconciliation, prescription monitoring, urine drug testing, controlled substance agreements, side effect review, sedation risk review, constipation management, overdose risk education, naloxone discussion, mental health review, sleep apnea risk review, pregnancy considerations, and coordination with other clinicians. MPM may also reassess whether opioid therapy is improving function and whether benefits continue to outweigh risks. Monitoring is used to support safety, not to stigmatize the patient.
A controlled substance agreement is a written plan that outlines expectations for safe opioid or controlled medication use. It may include how prescriptions are managed, refill policies, pharmacy expectations, medication storage, urine drug testing, prescription monitoring, and communication rules. The goal is to reduce risk and create clarity for both the patient and clinician. At MPM, controlled medication oversight is part of responsible prescribing when opioid therapy or other controlled medications are considered.
Opioid-induced hyperalgesia is a condition in which long-term opioid exposure may make some patients more sensitive to pain. It can be difficult to distinguish from worsening disease, tolerance, withdrawal, or a new pain generator. If pain becomes more widespread, intense, or less responsive to increasing opioid doses, MPM may reassess the diagnosis and medication plan. Management may involve dose adjustment, tapering, rotation, buprenorphine consideration, non-opioid strategies, pain psychology, procedures, or specialist coordination.
Physical dependence means the body has adapted to a medication and withdrawal can occur if it is stopped suddenly. Tolerance means the body may need a different dose to achieve the same effect over time. Addiction, or opioid use disorder, involves loss of control, cravings, continued use despite harm, and other behavioral and medical features. These terms are related but not the same. MPM discusses them carefully and without stigma when evaluating opioid therapy.
Buprenorphine is an opioid medication that may be used in different clinical contexts, including opioid use disorder treatment and selected pain care situations. Suboxone is one formulation that contains buprenorphine and naloxone. For some patients, buprenorphine-based care may be considered when opioid safety, tolerance, dependence concerns, or long-term risk are part of the clinical picture. It is not appropriate for every patient and requires careful timing, monitoring, and individualized medical judgment.
Yes. Pain psychology can be used alongside opioid therapy when clinically appropriate. It may help patients manage flare anxiety, medical trauma, fear of movement, sleep disruption, coping, communication, and function. Pain psychology does not mean the pain is imaginary, and it does not replace medication when medication is appropriate. For patients on opioid therapy, it can support safer, more functional care by helping address the full impact of chronic pain.
Opioid therapy may need to be tapered or changed when risks outweigh benefits, side effects become significant, function does not improve, medication interactions create safety concerns, opioid-induced hyperalgesia is suspected, or another treatment may be safer. Tapering should usually be patient-centered and gradual unless there is an urgent safety concern. Abrupt discontinuation can cause withdrawal and harm. MPM evaluates tapering carefully and may coordinate non-opioid medications, pain psychology, procedures, or other support.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Opioid therapy is a controlled medication strategy that may be considered for selected patients with severe, persistent, cancer-related, or complex chronic pain. It is not a default treatment, and it is not appropriate for every pain condition. Opioids can help some patients, but they also carry significant risks, especially with long-term use.
At Manhattan Pain Medicine (MPM), opioid therapy for chronic pain NYC care begins with diagnosis-first evaluation. The goal is to understand the pain condition, prior treatments, medication history, function, safety risks, and alternatives before deciding whether opioid therapy belongs in the care plan.
Opioids may be considered when pain is severe, functionally limiting, and not adequately managed with safer or more targeted options. This may include selected patients with cancer pain, severe complex chronic pain, or certain pain patterns where other treatments have not provided enough relief or are not appropriate. The decision depends on the diagnosis, medical history, prior treatment response, risk profile, and treatment goals.
MPM does not assume that opioid therapy is right or wrong for every patient. Some patients may benefit from careful opioid medication management. Others may be better served by non-opioid medications, procedures, infusions, pain psychology, pelvic specialty care, GI care, oncology care, rheumatology care, or buprenorphine-based strategies.
The goal of opioid therapy is not complete pain elimination. A more realistic goal may be improved function, safer medication use, reduced pain burden, improved daily participation, or better stability. If opioids do not improve function enough to justify the risks, the plan may need to change.
Long-term opioid therapy can involve constipation, nausea, sedation, mental fog, slowed breathing, overdose, physical dependence, tolerance, opioid use disorder, medication interactions, hormonal changes, mood effects, sleep disruption, and opioid-induced hyperalgesia. These risks must be reviewed regularly, especially when opioids are combined with sedatives, alcohol, sleep medications, or other medications that affect alertness or breathing.
Opioid therapy requires special caution in patients with abdominal pain, stomach pain, chronic constipation, gastroparesis, pelvic pain, or endometriosis-related pain. Opioids can slow bowel motility and may worsen constipation, nausea, bloating, abdominal discomfort, or bowel-related symptoms. This can complicate care for patients already struggling with GI or pelvic symptoms.
MPM evaluates whether opioid therapy is likely to help the patient’s pain pattern or whether it may worsen the overall symptom burden. If opioids are used, bowel regimen planning, side effect monitoring, and coordination with GI, pelvic specialists, oncology, or other clinicians may be needed.
Safe opioid therapy may involve prescription monitoring, urine drug testing, controlled substance agreements, medication reconciliation, pharmacy coordination, naloxone discussion, pill counts in selected situations, side effect monitoring, and ongoing reassessment. These steps are not meant to punish patients. They are part of responsible prescribing.
MPM also evaluates mental health, sleep apnea risk, fall risk, liver or kidney considerations, pregnancy considerations, overdose risk, and medication interactions. If a patient is already taking opioids, MPM reviews whether the current regimen is safe, effective, and connected to a broader treatment plan.
For selected patients, buprenorphine or Suboxone may be considered as part of pain medication management, especially when opioid safety, tolerance, dependence concerns, or long-term opioid risk are part of the picture. These medications are not appropriate for everyone and require careful timing and supervision, especially when transitioning from full opioid agonists.
Non-opioid medication options may also be considered, including anti-inflammatory medications, neuropathic pain medications, topical treatments, migraine medications, muscle-related medications, and disease-directed therapies for autoimmune or inflammatory conditions. Procedures, infusions, pain psychology, biofeedback, acupuncture, and rehabilitation may also help reduce reliance on opioids when clinically appropriate.
If opioid risks outweigh benefits, MPM may discuss tapering or changing the medication plan. Tapering should generally be patient-centered and gradual unless there is an urgent safety concern. Abrupt discontinuation can cause withdrawal, distress, worsening pain, and unsafe outcomes. A thoughtful taper may include non-opioid medication support, pain psychology, procedures, buprenorphine consideration, and coordination with other clinicians.
Patients should seek urgent medical care for trouble breathing, severe sedation, confusion, suspected overdose, blue lips, inability to wake, chest pain, severe allergic reaction, suicidal thoughts, severe withdrawal symptoms, severe abdominal pain, black or bloody stool, persistent vomiting, bowel obstruction symptoms, new neurological deficits, bowel or bladder dysfunction, saddle anesthesia, or rapidly worsening symptoms.
For selected patients, opioid therapy may be one tool within chronic pain care. MPM’s role is to determine whether it is appropriate, monitor it carefully, address risks, and keep medication decisions connected to diagnosis, function, safety, and coordinated treatment.
