Pain and Opioids Stewardship aligns compassionate pain relief with overdose prevention, dignity, and function. pain stewardship conference Start with a whole-person map: likely pain generators (nociceptive, neuropathic, centralized), medical contributors, sleep and circadian health, mood and trauma history, substance use, daily roles, and goals that actually matter to the patient—lifting grandchildren, finishing a shift, sleeping through the night. Build a plan that leads with non-opioid, multimodal strategies—NSAIDs/acetaminophen when safe, SNRIs/gabapentinoids for neuropathic patterns, topical agents, targeted procedures, PT/OT, graded activity, and CBT-based pain skills—then add or continue opioids only when the benefits for function and relief clearly outweigh risks. When opioids are used, make the guardrails explicit: the smallest effective dose, avoidance of benzodiazepine co-prescribing, respiratory risk screening (age, OSA, COPD), naloxone co-prescription, and written review points to revisit fit. Perioperative care demands choreography, not guesswork: continue buprenorphine for patients with OUD, use regional anesthesia and non-opioid adjuncts, and communicate the plan to surgeons, anesthesia, ED, pharmacy, and primary care so patients are not bounced or undertreated. Urine drug testing and PDMP checks should inform—not punish—decisions, with plain-language conversations that keep the alliance intact. Tapering, when indicated, is a treatment: go slow, tie dose changes to function, sleep, and safety, and pause or reverse if life worsens. Equity turns intent into impact: interpreters, large-print materials, transport and tele options, and cost navigation for PT/OT and non-opioid meds. Special populations require nuance—older adults (falls, cognition), perinatal patients (risk–benefit and lactation), chronic kidney/liver disease (dosing), and people with SUD (harm-reduction, MOUD continuation, contingency management for adherence). Track what matters: function, participation, sleep, mood, and adverse events, not just morphine milligram equivalents. Hold weekly cross-disciplinary huddles to refine pathways, share wins, and close disparity gaps. Pain care earns trust when it reduces suffering, protects safety, and helps people reclaim the roles that make life meaningful.