Prescription Opioids, Brain Structure, and Cognition in Older Adults With Chronic Pain

Inclusion Criteria:

* 65 years of age or older
* Pain for longer than 3 months (chronic)
* Moderate to severe pain nearly every day (averaged PEG score \>5)
* Persistent pain despite use of \>1 analgesic (Tylenol, Ibuprofen, lidocaine patch, etc)

Exclusion Criteria:

* Untreated severe/uncontrolled Mental health (schizophrenia, bipolar disorder, psychosis, history of suicidality, depression or anxiety, PTSD)
* Severe liver (cirrhosis) or kidney disease (ESRD on dialysis or GFR\< 30)
* Cognitive impairment (Kokmen Short Test of Mental Status score \< 29)
* Life expectancy \< 12 months
* Contraindications to MRI
* Non-English speaking
* Opioid use within the past 6 months
* Contraindications or previous intolerance to prescription opioids
* Substance use disorder or high-risk for opioid-related adverse effects (Opioid Risk Tool ≥ 8)
* Residence outside of Minnesota or Wisconsin during opioid intervention period
* Another pain generator that is greater than their knee or shoulder or low back pain
* Anticipated surgery for joint replacement (Knee or shoulder) sooner than 3 months.