Dr. Gurpreet Singh Padda, MD on Veterans Day: The System Solved the Prescription and Did Not Solve the Pain

Half of veterans live with chronic pain. Dr. Padda looks at what happened after the VA cut opioid prescribing, and at an injection with randomized PTSD evidence

ST. LOUIS, MO, UNITED STATES, November 11, 2026 /EINPresswire.com/ — Dr. Gurpreet Singh Padda, MD, MBA, MHP, who directs an interventional pain practice in St. Louis, is marking Veterans Day by separating two outcomes that are routinely reported as one. Between 50 and 60 percent of veterans treated in the VA system live with chronic pain, and roughly 11 percent receive opioids chronically. Those figures describe a population carrying more pain than the civilian average, and carrying it longer.

In 2013 the Veterans Health Administration launched its Opioid Safety Initiative. By the measure it set for itself, it worked: the number of VA patients maintained above 100 morphine milligram equivalents per day fell from roughly 60,000 in fiscal 2012 to over 35,000 in fiscal 2016. Dr. Padda calls that a real institutional achievement and an incomplete clinical one.

“The VA proved you can bring the numbers down,” Dr. Padda said. “Nobody has shown the pain came down with them. Those are two different outcomes and we keep reporting the easier one.”

The distinction is not rhetorical. A dose reduction is arithmetic performed on a prescription. Treating the structure generating the pain changes why the prescription existed. Only one of those is visible on a dashboard, and it is not the one that determines how a veteran feels at the end of it.

There is also a population effect the aggregate numbers conceal. A veteran whose dose came down because a pain generator was identified and treated is in a different clinical position from one whose dose came down because a threshold was applied to their chart, even though both appear identically in the reporting. The first has fewer milligrams and less reason to need them. The second has fewer milligrams and the same disease.

The injection with a randomized trial behind it

Among interventional options, one has accumulated evidence in a population where veterans are heavily represented. The stellate ganglion block, a local anesthetic injection near the sympathetic nerves in the neck, has been used for decades in complex regional pain syndrome and certain head and face pain conditions. Its application in post-traumatic stress disorder is newer, and better studied than most people realize.

In the first multisite randomized clinical trial, 113 active-duty service members with elevated PTSD symptoms received either two stellate ganglion blocks or two sham injections two weeks apart, alongside usual care. At eight weeks, scores on the Clinician-Administered PTSD Scale for DSM-5 had fallen an average of 12.6 points in the block group against 6.1 in the sham group, a difference exceeding the 10-point change generally regarded as clinically meaningful (Rae Olmsted KL et al., JAMA Psychiatry 2020;77(2):130-138).

Evidence since is mixed and the field is honest about it. Two randomized trials produced conflicting results, neither assessed durability past eight weeks, and the mechanism remains incompletely understood. More recent work at Ohio State found benefit when the block was delivered after cognitive processing therapy in patients who had not responded to therapy alone, which points at sequencing rather than at the block as a standalone answer.

“It buys a window,” Dr. Padda said. “What the patient does inside that window is what actually determines the outcome.”

The metabolic consequence of a nervous system that never stands down

The reason a sympathetic block is plausible in PTSD at all points to something with consequences well beyond mood, and it is the part of veteran health that pain medicine and endocrinology each tend to leave to the other.

Sustained sympathetic activation raises circulating catecholamines, which suppress insulin secretion and drive lipolysis. Cortisol dysregulation follows, and abdominal adipose tissue is unusually cortisol-responsive. The result is central adiposity, which then secretes inflammatory cytokines that further degrade insulin sensitivity, and that sensitize the same nociceptive pathways generating the patient’s pain. The loop closes on itself, and every turn of it makes the next turn easier.

The epidemiology matches the mechanism. Pooled prevalence of metabolic syndrome in people with PTSD is 38.7 percent, and among veterans with PTSD, 43 percent meet criteria, with severity of PTSD tracking likelihood of metabolic syndrome, and elevated rates persisting even in veterans whose overall body weight appears normal.

That last detail matters clinically and is the reason Dr. Padda raises it on a day devoted to veterans rather than at a metabolic conference. A veteran with PTSD, chronic pain and a normal BMI can still be metabolically ill in a way that keeps their pain amplified, and will be missed by every screening tool that starts with the scale.

“Forty-three percent of veterans with PTSD meet criteria for metabolic syndrome,” Dr. Padda said. “That is not a coincidence of lifestyle. That is what fifteen years of sympathetic overdrive does to a body.”

Dr. Padda regards 43 percent as a low estimate for exactly that reason: the count starts with the scale.

The practice evaluates and treats chronic pain, PTSD-related symptoms and metabolic dysfunction together rather than sequentially, on the position that the autonomic, inflammatory and structural components sustain one another and that addressing any one of them alone leaves the other two free to undo the work.

Related reading:
Addiction, chronic pain and type 2 diabetes as one substrate: https://painmd.tv/addiction-pain-diabetes-metabolic-syndrome/
Neck Pain STL, the block and what it tests: https://neckpainstl.com/stellate-ganglion-block/
Addictionology Center, when an opioid dose falls because the pain was treated: https://addictionology.center/opioid-dose-falls-because-pain-treated/

About Padda Institute Center for Interventional Pain Management

Padda Institute Center for Interventional Pain Management is a physician-led chronic pain practice in St. Louis, directed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, who is board certified in anesthesiology and interventional pain management. The practice is interventional-first, using image-guided diagnosis and treatment to identify and address the specific source of pain. It serves the St. Louis region, Missouri and Illinois.

4477 Woodson Road, Suite 100, St. Louis, MO 63134
12174 Natural Bridge Road, St. Louis, MO 63044
(314) 481-5000 – painmd.tv

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