Why Your Pain Medication Stops Working

You have been taking the same medication for months. It helped at first. Now it barely touches the pain. You take more of it than you used to. You wonder if something changed, or if you are just getting worse.

In many cases, neither of those things is true. The pain did not change. You did not change. The medication stopped matching your biology as well as it once did, and there is a specific reason that happens.

Dr. Nidal Elbaridi sat down with pharmacist Nima Matin on Episode 3 of Inside the Loop to talk through exactly this: why pain medications work differently for different patients, what that means for how pain should actually be managed, and what injured patients in Illinois need to know about getting their prescriptions covered without paying anything out of pocket.

Why the Same Dose Affects People Differently

Not everyone metabolizes medication the same way. Your body processes drugs through specific metabolic pathways, and your genetics determine how fast or slow those pathways run.

Some people are rapid metabolizers. A medication that would provide six hours of relief for one patient is cleared from their system in two. The drug was never ineffective. It just did not stay long enough to do the job. Other people metabolize the same drug so slowly that a standard dose accumulates and causes side effects before it ever reaches its therapeutic window.

This is the field of pharmacogenomics: the study of how your genetic profile affects how you process medications.

Nima Matin, a pharmacist with 15 years of clinical experience and a specialization in geriatric pharmacology, explained it on the podcast: an oral cheek swab sent to a lab can analyze the metabolic pathways relevant to your prescriptions and tell your physician exactly where your system may be varying from the standard expectation. There are roughly 600 medications with known genetic implications in how they are processed. Many of the most commonly prescribed pain medications are on that list.

If you have tried multiple pain medications and found them inconsistent or ineffective, the answer may not be a different drug. It may be a clearer picture of how your body handles the drugs you have already tried.

Why Opioids Are Not the Starting Point

One of the most direct moments in the podcast was when Dr. Elbaridi and Nima discussed how the United States handles pain medication compared to the rest of the world.

The United States represents roughly 5 percent of the global population and consumes approximately 90 percent of the world’s hydrocodone. That number is not a reflection of Americans being in more pain. It is a reflection of a prescribing culture that defaulted to opioids as a first response for decades.

In most other countries, opioid prescriptions are reserved for hospitalized patients with severe injuries. An outpatient walking into a clinic and leaving with an opioid prescription is not the norm anywhere else in the developed world.

Dr. Elbaridi’s practice is built on a different model. Before any treatment decision, he performs a physical examination, reviews imaging, and works to identify the specific structure causing the pain. A nerve root compression is not the same as a facet joint injury, which is not the same as a muscular trigger point. Treating all of them with the same medication is not pain management. It is symptom suppression.

When the diagnosis is clear, the treatment options include targeted injections, nerve blocks, radiofrequency ablation, spinal cord stimulation, and physical rehabilitation, alongside medication when it is appropriate and proportionate. Opioids have a role. That role is narrow, and it comes after other options have been properly considered.

If You Were Injured at Work or in an Accident, Your Medications Should Not Cost You Anything

One of the most practical things covered in this episode is something most injured patients in Illinois do not know.

If you were injured on the job or in a car accident and your case is being handled as a workers’ compensation or personal injury claim, any prescription related to that injury does not have to go through your regular insurance. It does not have to come out of your pocket at all.

Nima Matin runs a workers’ compensation and personal injury pharmacy that operates on a lien basis. When a physician sends a prescription for an injured patient, his pharmacy contacts the patient, gathers their information, and ships the medication overnight via FedEx. The cost is billed directly to the workers’ compensation carrier or, in a personal injury case, issued as a lien against the eventual settlement. If the claim is denied, the patient is not billed.

Most retail pharmacies will run the prescription through regular insurance and charge whatever copay or deductible applies. That process has nothing to do with your workers’ comp or PI case, and it leaves money on the table that is legally available to you.

Loop Medical Center works directly with workers’ compensation and personal injury patients. If you were injured and have an open case, call us before you assume you know what your treatment will cost.

What the Podcast Episode Covers

Episode 3 of Inside the Loop features Dr. Nidal Elbaridi in conversation with pharmacist Nima Matin. The full episode covers:

• What a consulting pharmacist does inside a nursing home and why it affects medication safety for elderly patients
• How pharmacogenomics testing works and which patients benefit most
• The workers’ comp and personal injury pharmacy model, including how the lien process works
• Why the US opioid consumption rate is what it is, and what a responsible alternative looks like
• Dr. Elbaridi’s multimodal treatment philosophy and how a pharmacist fits into it
• Unregulated peptides, TRT, and GLP-1 medications: what the data supports and what to be cautious about

Watch the full episode:

About our guest:
Nima Matin is a pharmacist with 15 years of experience, specializing in geriatric pharmacology and workers’ compensation pharmacy. He runs a pharmacy consulting company serving over 350 nursing homes across 15 states, and a separate workers’ comp and personal injury pharmacy based in Oakbrook Terrace, Illinois.

Visit Nima Matin’s pharmacy practice Focused Care Consulting

When to Talk to Dr. Elbaridi About Your Medications

Schedule a consultation if any of the following apply:

• You are taking medication for chronic pain and the relief has diminished over time
• You have tried multiple medications without finding one that works reliably
• You were injured at work or in an accident and are paying for prescriptions out of pocket
• You are on opioid medication and want to explore whether a more targeted approach could reduce your dependence on it
• You have never had a physician explain why your pain medications work the way they do

Same-week appointments available at both Loop Medical Center locations.

Frequently Asked Questions

Why does pain medication work for a while and then stop being effective?

There are two common reasons. The first is tolerance: your nervous system adapts to a consistent medication level and requires more to produce the same effect. The second is pharmacogenomic mismatch: your genetics may cause you to metabolize the medication faster than expected, so the therapeutic level never lasts as long as the standard dosing schedule assumes. A pharmacogenomics test can identify whether your metabolic pathways are affecting how your prescriptions perform.

What is a workers’ comp pharmacy and how does it work in Illinois?

A workers’ comp pharmacy bills the injured patient’s employer insurance carrier directly, or in a personal injury case, issues a lien against the eventual settlement. The patient receives their prescription, often delivered overnight, without any upfront cost. If the claim is denied, a legitimate workers’ comp pharmacy does not bill the patient. This model ensures injured workers can access their medications while their case is still open.

Are opioids ever appropriate for pain management?

Yes, in specific circumstances: severe acute injury, cancer-related pain, or terminal diagnosis. For most chronic pain conditions treated in an outpatient setting, they are not a first-line intervention. Interventional approaches address the structural source of pain more precisely and without the dependency risk of long-term opioid use.

What is pharmacogenomics and do I need to be tested?

Pharmacogenomics is the study of how your genetic makeup affects how you process medications. It involves a simple cheek swab analyzed by a lab. Testing is most useful when you have had inconsistent results with pain medications, when your physician is choosing between multiple options, or when you are an older patient on several medications and drug interactions are a concern.

Can I switch from opioids to a non-opioid treatment?

In many cases, yes. The process depends on what is causing your pain, how long you have been on opioids, and which alternatives are appropriate for your diagnosis. Dr. Elbaridi evaluates each patient individually. The first step is a thorough physical exam and review of your imaging and medication history. From there, he can tell you which interventional options are relevant and what a realistic transition plan looks like.

If my workers’ comp claim is denied, do I owe money to the pharmacy?

If you are working with a legitimate workers’ comp or personal injury pharmacy on a lien model, no. These pharmacies absorb the cost if the claim is denied. A retail pharmacy has no lien arrangement and will collect from you regardless of how the claim resolves.

Ready to Talk About Your Pain Management?

If your current medications are not giving you the relief they used to, or if you are managing pain from a work injury or accident and want to understand your options, the right next step is a conversation with Dr. Elbaridi.

Call or text: (312) 414-108

South Loop: 1921 S Michigan Ave, Chicago, IL 60616
Streeterville: 432 E Grand Ave, Suite A, Chicago, IL 60611

Workers’ Compensation and Personal Injury cases accepted. Letter of protection available.