Founder and medical director
Dr. Gurpreet Singh Padda, MD, MBA, MHP is the founder and medical director of DWARAA, and the physician responsible for the clinical content on this site. He is board certified in anesthesiology, pain medicine, interventional pain, addiction medicine and obesity medicine, and has practiced in St. Louis for more than three decades.
The clinical positions the framework works from are his: that medication burden in older adults is usually higher than it needs to be, that deprescribing is a formal discipline rather than a lapse, and that a taper done to a patient is a different intervention, with different outcomes, from one done with them.
Why a pain and addiction physician runs a geriatric deprescribing program
Because the classes that most often need review in an older adult — opioids, benzodiazepines, Z-drugs, antipsychotics, gabapentinoids — are the classes an interventional pain and addiction medicine practice deals with every day, in a population where the margin for error is narrower. The subject is usually filed under dementia care. It is more accurately filed under stewardship.
That background also explains the framing this site refuses. The evidence on what happens when opioid tapering is imposed rather than agreed is unambiguous, and the CDC has said so about the misapplication of its own guideline. A program that repeated that error in a nursing home, with people less able to object, would be doing harm with better paperwork.
Clinical positions this site is built on
- Deprescribing guidelines are critical in older adults, and deprescribing is a discipline with named tools, not an improvisation. The deprescribing step.
- Statin use is associated with new-onset type 2 diabetes — a documented, FDA-labeled trade-off to weigh with a prescriber, not a reason for anyone to stop a statin alone. Statins in the very old.
- Overuse of antihypertensives is a major contributor to falls through orthostatic hypotension, with the morbidity that follows. Antihypertensives.
- Stewardship is not abstinence. For a patient with irreversible pain the goal is not zero opioids — it is minimizing use and preventing harm, including the harm of untreated pain. Opioids in older adults.
Published outcomes behind the tapering position
The distinction this site draws between a taper and a withdrawal is one he has published figures on. On International Overdose Awareness Day in August 2026 his interventional pain practice released its own opioid data: an average arrival dose above 90 morphine milligram equivalents a day after more than two and a half years in pain, 21% of patients completely off opioid pain medication within 90 days of active treatment and 34% within one year, and most of the remainder held below 30 MME a day.
The stated mechanism is that reducing a dose and treating the reason for the dose are different interventions. Those are practice-reported figures from his own patient population, not trial outcomes, and individual results vary. Reported by AP News; the full release is here.
Training and academic background
- BA in Biology and MD, University of Missouri–Kansas City.
- General surgery residency, Cook County Hospital / University of Illinois–Chicago.
- Anesthesiology residency, Illinois Masonic, then Washington University–Barnes, with pediatric anesthesia at St. Louis Children’s Hospital; chief resident 1991–92.
- MBA, Saint Louis University. Certified Physician Executive, American College of Physician Executives.
- Assistant Professor of Anesthesiology and of Pediatrics, Cardinal Glennon and Saint Louis University; Associate Director of Pediatric Anesthesiology and Director of the Pediatric Acute Pain Service; Deputy Director of the Saint Louis University Institutional Review Board.
- Faculty, Kansas City University / Freeman Health System psychiatry residency, in pain and addiction.
Society leadership and national presentations
- President, Missouri Society of Interventional Pain Physicians — 2002 to 2010, and from 2023.
- Board member and examiner, American Board of Interventional Pain Physicians.
- Board of Directors, American Society of Interventional Pain Physicians.
- Two ASIPP keynote addresses — “Treating Metainflammation and Interventional Pain” (2020) and “Metabolic Inflammation and the Hedonic Treadmill” (New Orleans, 2021).
- Review editor, PharmacoEconomics. Published in Neuromodulation, Pain Medicine, Critical Care Medicine, Anesthesia & Analgesia, Paediatric Anaesthesia, Ophthalmology, Dermatologic Surgery, the Southern Medical Journal and Pain Physician.
Role on this site
Dr. Padda writes and reviews the clinical content published here. Every clinical page carries a visible review byline with the date it was last reviewed, and the same attribution appears in the page’s structured data.
What DWARAA is, and is not
DWARAA does not prescribe, deprescribe, diagnose or treat. Those are decisions made by a patient and their own clinicians, with the whole record in front of them. What DWARAA supplies is the framework, the evidence behind it, and the shared vocabulary that lets a family, a nurse, a facility and a prescriber talk about the same medication list and mean the same thing.
He also serves as the Authorized Official of CareGuard, the AHRQ-listed Patient Safety Organization operated by the same foundation, and is the point of contact on its federal listing.
Identifiers
National Provider Identifier 1427035955 · Missouri medical license MD 100572 · Wikidata Q141049117
Board certifications, societies and affiliations
Common questions
Does Dr. Padda treat patients through DWARAA?
No. DWARAA is a nonprofit division of a foundation and delivers no care. It does not prescribe, deprescribe, diagnose or treat. His role here is authorship and clinical review of the content. About DWARAA.
Who reviews the clinical content on this site?
Dr. Gurpreet Singh Padda, MD, MBA, MHP. Every clinical page carries a visible “written and medically reviewed by” line with the date of last review, and the same attribution is emitted in the page’s structured data so it is machine-readable. The evidence base.
What the evidence does and does not show
Sedating medications impair gait, balance and reaction time, and their labels say so. That part is not in doubt. What has not been shown is that a deprescribing program reduces fall rates — the trials that tested it were small, short, and mostly measured a medication count rather than a fracture. Those are two different questions, and absence of evidence from underpowered trials is not evidence that the drugs do not cause falls. What the evidence actually shows about deprescribing and falls.
References
- Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports. 2022;71(3):1–95. PMID 36327391 · DOI 10.15585/mmwr.rr7103a1.
- By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052–2081. PMID 37139824 · DOI 10.1111/jgs.18372.
- Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. The Lancet. 2010;375(9716):735–742. PMID 20167359 · DOI 10.1016/S0140-6736(09)61965-6.
- Cholesterol Treatment Trialists’ (CTT) Collaboration. Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis. The Lancet Diabetes & Endocrinology. 2024;12(5):306–319. PMID 38554713 · DOI 10.1016/S2213-8587(24)00040-8.
- Gnjidic D, Langford AV, Jordan V, et al. Withdrawal of antihypertensive drugs in older people. Cochrane Database of Systematic Reviews. 2025;3(3):CD012572. PMID 40162571 · DOI 10.1002/14651858.CD012572.pub3.
Written and medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, founder and medical director of DWARAA. Last reviewed . This page is educational. DWARAA does not prescribe, deprescribe, diagnose or treat.