Why Medications, Procedures, and Surgery May Not Fix Chronic Pain

If you were injured years ago and the injury has long since healed, but the pain never left, you are not imagining it — and more medication may not be the answer. In a conversation with Dr. Tony Hampton, Dr. Gurpreet Padda explained why this kind of long-lasting pain often does not respond to stronger drugs or another procedure, and why he looks at metabolic inflammation instead. This article summarizes the medical ideas from that discussion.

Two very different kinds of pain

Dr. Padda drew a clear line between two types of pain. The first is acute pain — the kind you feel if your foot is run over by a truck. It hurts intensely, it may need surgery or an orthopedic procedure, and over a short time the injury heals and the pain resolves. The second, and the focus of the conversation, is pain that outlives the duration of the injury: someone was hurt five, seven, or ten years ago, the tissue healed, yet the pain persists. He said this second kind is what the vast majority of people with ongoing pain are actually dealing with — and it is a fundamentally different problem than a fresh injury.

Why more narcotics stop working

The standard response to persistent pain is often more and stronger narcotics, and Dr. Padda explained why that approach tends to fail. The human nervous system is highly adaptive: give it an opioid, and it quickly adjusts by up-regulating its receptors, so the drug loses effect. In the conversation he described the medication working reasonably for roughly the first 28 to 30 days, but by around 60 days a person needs more and more drug to get the same relief. That escalation, he argued, does not address why the pain is still there in the first place — it just chases a moving target.

The overlooked driver: metabolic inflammation

After more than twenty years and, as he stated, treating on the order of 65,000 to 70,000 patients, Dr. Padda said his clinic concluded that persistent pain is frequently an issue of metabolic inflammation — a problem of the body’s metabolism rather than the original injury. He cited a striking figure from the conversation: only about 12.2% of people in the U.S. are metabolically healthy, meaning the large majority are metabolically unwell. In his framing, if you cannot fix a patient’s diet, you cannot fix their pain — and he described addressing metabolism as something his clinic works on every day. These patient counts and percentages are figures he cited in the interview; individual results vary.

What this means for evaluation at the Padda Institute

The practical implication Dr. Padda drew is that chronic pain should be evaluated as part of a person’s overall metabolic health, not treated only as a local structural problem. In the conversation, he and Dr. Hampton noted that metabolic health connects to many conditions people rarely link to pain — diabetes, high blood pressure, dementia, and cancer among them — so improving it may bring benefits well beyond pain relief. At the Padda Institute, the emphasis is on identifying and addressing those underlying metabolic drivers, including diet, rather than defaulting to escalating medications. This reflects the clinic’s practice-based approach and is not a promise of any specific outcome.

Frequently asked questions

If my injury healed years ago, why do I still have pain?

Dr. Padda distinguishes pain that outlives the original injury from a fresh injury, and attributes much of it to metabolic inflammation rather than unhealed tissue. In his view, that is why the pain persists long after the injury should have resolved. This is a practice-based framework, and individual results vary.

Why don't stronger pain pills fix long-term pain?

Because the nervous system adapts to opioids by up-regulating its receptors, so tolerance builds — Dr. Padda described a drug working for roughly 28 to 30 days, then needing higher doses by around 60 days. Escalating medication chases the symptom without addressing why the pain remains. Individual results vary.

Should I stop my pain medication to work on my metabolism?

No — do not start, stop, or change any medication without consulting your physician. Dr. Padda's clinic works to identify and treat underlying metabolic drivers over time and, where appropriate, helps patients wean under supervision; this is not something to attempt alone. Individual results vary.

Where are you located and how do I book?

Padda Institute Center for Interventional Pain Management, 4477 Woodson Road, Suite 100, St. Louis, MO 63134. Book at painmd.tv/appointment/ or call (314) 481-5000.

Key takeaways

• Pain that outlives a healed injury is a different problem than acute injury pain and needs a different approach.
• The nervous system adapts to narcotics, so tolerance builds and escalating doses rarely fix long-term pain.
• Dr. Padda attributes much persistent pain to metabolic inflammation, citing that only about 12.2% of Americans are metabolically healthy.
• Next step: have the metabolic drivers of your pain evaluated at the Padda Institute rather than relying on medication alone.

Medically reviewed by Gurpreet Singh Padda, MD — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed July 2026.

This article is educational and is not a substitute for evaluation, diagnosis, or treatment by a physician. Individual results vary. Do not start, stop, or change any medication without consulting your physician.

Gurpreet Singh Padda , MD, MBA, MHP