I don't know whata Kaiserpermanente is. This is my experience with spinal stenosis. The surgeon gave me two choices stay on the pills forever or an operation with no guarantee. had the operation. I went from 10 pills a day to 5 a day. I'm now down to 3 a day. I've tried a lot of things to reduce pain. The most successful, unbelievably so, is the combination of acupuncture and lazar. I'm still on Tramadol but I've reduced the number of pills and extended the time between the ones that I'm taking.
I discovered to my sorrow, going cold turkey off Tramadol, is not a good idea.
Best of luck! What works for one, doesn't work for another.