Need a lot more info—especially why she was tapered. Were there concerns for misuse? Running out early? Or clinic simply said ‘we now have a policy that people shouldn’t be on greater than X amount of opioids’.
For patients on LTOT without misuse you continue the original dose. Force tapering is inappropriate, dangerous, and may lead to suicide when there is not compelling evidence to taper. Providers have a duty to these legacy opioid patients. We put them on opioids—it’s wholly wrong to cut them off without a better alternative, explanation why a taper may be helpful, going very slow, and having the option of going back if the new plan fails. There are clear risks of LTOT, but there are risks, like you’ve seen, of also fast tapering someone without full buy in.
There are other things you can do—ketamine infusions, methadone instead of another full agonist(but often providers are reluctant to do this), suboxone or suboxone+butrans. I’ve transitioned high dose LTOT patients to partial agonist and they’ve done better, but it has to be a joint decision.
Gabapentin is useless, potentiates opioid and puts person at higher risk. SNRIs are often not helpful unless the pain is certain neuropathies. There is often a trauma history and ptsd and pain mutually maintain one another—seeing a trauma therapist can be helpful.