If you have lived with pain for months, you have probably been offered medication more than once. You may also have been told that stronger medication is the only option left. That is not how we practise.
At TOPS Institute, our approach focuses on identifying and treating the underlying source of pain rather than masking symptoms with long-term medications. For this reason, we generally do NOT prescribe opioid (narcotic) medications for chronic pain.
This article explains what we offer instead, and why targeting the source tends to produce better long-term results.
Why opioids are rarely the answer for chronic pain
Opioids reduce the perception of pain. They do not repair a compressed nerve root, calm an arthritic facet joint, or restore a degenerated disc. When the underlying problem is structural, medication alone leaves the cause untouched.
Long-term use also brings well-known trade-offs: tolerance, dependence, and side effects that interfere with sleep, mood, work and driving. Patients often describe feeling foggy but still sore.
The more useful question is not how do we turn the volume down? but what exactly is generating this signal, and can we treat it directly?
Step one: find the actual source
Pain is a symptom, not a diagnosis. The same symptom — lower back pain radiating into the leg — can come from a herniated disc, spinal stenosis, an arthritic facet joint, or the sacroiliac joint. Each responds to a different treatment.
Our evaluation may include:
- A detailed history of how and when symptoms began
- Physical and neurological examination
- Review of MRI, CT or X-ray imaging
- Electromyography (EMG) and nerve conduction studies
- Diagnostic injections or nerve blocks
Diagnostic blocks matter more than most patients expect. If numbing a specific nerve reliably relieves your pain, that tells us the pathway is genuinely involved — and it tells us whether a longer-lasting treatment aimed at that nerve is likely to work.
Step two: treat that source directly
Once the source is confirmed, treatment is matched to the tissue involved.
Image-guided injections
Using fluoroscopic X-ray or ultrasound guidance, medication is delivered precisely to the structure causing symptoms — an inflamed nerve root, a facet joint, a bursa or a joint space. Epidural Steroid Injections are commonly used for nerve-related pain in the neck or lower back.
Nerve blocks and radiofrequency ablation
Where diagnostic blocks confirm that specific nerves carry the pain signal, Radiofrequency Ablation uses controlled heat to interrupt that signal. Relief commonly lasts approximately six to twelve months, and the procedure can be repeated when symptoms return.
Regenerative treatment
For selected tendon, ligament and joint conditions, High-Dose PRP uses a concentrated preparation of your own platelets to support the body’s healing response. It is not appropriate for every injury, and a full evaluation is needed to judge whether the tissue is likely to respond.
Neuromodulation
For certain patients with chronic neuropathic pain that has not responded to conservative care, Spinal Cord Stimulation and Peripheral Nerve Stimulation can modify pain signals before they reach the brain. Patients trial the system before any long-term decision.
Rehabilitation
Pain relief alone does not correct the weakness, stiffness or movement pattern that contributed to the problem. Targeted procedures are usually combined with a structured rehabilitation plan, which is often what makes the relief last.
What this means for you
Choosing an opioid-free practice does not mean choosing to live in pain. It means the plan is built to change the underlying condition rather than to keep you medicated around it.
Most patients we see have already tried rest, medication and time. What they have often not had is a precise diagnosis — and that is usually where meaningful progress begins.