Programs
Chronic Pain & Metabolic Care
The pain that keeps someone out of work, and the metabolic disease underneath it — assessed together, because they are the same problem.
Pain is a signal, not the disease
The terrain model that governs this program is straightforward: symptoms are signals, and durable recovery comes from correcting the underlying structure rather than suppressing what it is broadcasting.
In practice that means a person arriving with back pain gets assessed for the metabolic inflammation, sleep disruption, unmanaged blood sugar and nervous-system state that are amplifying it — not just imaged and prescribed.
What gets assessed
- The pain itself: where, how long, what changes it, what has already been tried
- Metabolic markers, including the inflammation that drives pain amplification
- Sleep, which is both a cause and a casualty
- Current medications, and whether any are now doing more harm than good
- Function — what you cannot currently do that you need to be able to do
Why this matters for this population
Unmanaged pain is one of the most reliable ways a housing placement fails. Someone who cannot sit, stand or sleep cannot hold a job, cannot tolerate a congregate setting, and will eventually self-medicate with whatever is available. Treating the pain properly is not comfort care here. It is housing retention.
Opioid stewardship
This program reduces opioid burden. Where someone arrives on a high dose, the work is to taper safely with something better in place — not to abandon them, and not to continue indefinitely.
“You cannot correct anybody’s metabolism from a bus stop.”
Dr. Gurpreet Singh Padda, MD, MBA, MHP
Think this might be for you?
You do not need a referral and you do not need to prove anything first. Tell us what is happening and we will be honest about whether we can help.
Why the two are treated together
Chronic pain and metabolic disease are not separate problems that happen to co-occur. Poorly controlled blood sugar impairs how tissue repairs itself, raises inflammatory load and worsens nerve pain directly. Pain in turn disrupts sleep and activity, which worsens glucose control. Treating either alone tends to produce a short result.
For people who have been unhoused, both arrive further along than they would otherwise. Diabetes discovered at the point of a foot ulcer, hypertension discovered at the point of a crisis, pain that has been present for years without anyone identifying its source.
What assessment involves
- A history that covers pain, sleep, mood, substance use and housing together, because they are not separable.
- Blood work establishing glucose control, kidney function, vitamin D and inflammatory markers.
- Identification of the pain generator where one can be found, rather than treating the symptom indefinitely.
- A medication review, including what was started years ago and never revisited.
- A written plan you keep a copy of.
Medication, and what we are trying to reduce
Long-term opioid therapy tends to produce diminishing benefit and increasing cost over time, and abrupt discontinuation is itself a recognized harm. Neither of those is a reason to leave a regimen unexamined. Where the source of pain can be identified and treated directly, the medication requirement usually falls on its own, which is a different mechanism from tapering by willpower.