No Gain, More Pain

January 15th, 2019

Physical therapy provides viable alternative to opioid use for pain management.

With the opioid epidemic ravaging much of America, some policymakers are calling for more drug-treatment facilities, stricter monitoring of opioid prescriptions and harsh penalties for drug companies and doctors who abuse the system. But according to the U.S. Centers for Disease Control and Prevention, one of the most effective ways to combat opioid addiction – physical therapy – often gets overlooked.

Through physical therapy, many patients can address the root cause of chronic pain and learn to either live with it or manage it without opioid medications. In its recent report "Guidelines for Prescribing Opioids for Chronic Pain," the CDC said opioids should not be the first treatment option for chronic pain because they come with too many side effects and are far too addictive.

Instead, the CDC said, doctors “should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain. Many non-pharmacologic therapies, including physical therapy … can ameliorate chronic pain.”

Alice Bell, senior payment specialist for the American Physical Therapy Association, said there is a growing understanding in the medical community that helping patients avoid surgery through physical therapy is one key to preventing opioid dependency.

“Across the profession, we’re seeing more and more patients who are accessing physical therapy before opioids are prescribed, or who've been on opioids but realize they aren't helping to treat or manage their underlying conditions,” Bell told the APTA’s magazine, PT in Motion. “Numerous studies have shown the efficacy of physical therapy for pain management.”

The APTA recently published a whitepaper on the subject reporting that chronic pain lasting longer than three months affects about 100 million American adults and comes at an annual economic cost of almost $600 billion. According to the U.S. Department of Health and Human Services, “wide variations in clinical practice, inadequate tailoring of pain therapies to individuals and reliance on relatively ineffective and potentially high-risk treatments such as inappropriate prescribing of opioid analgesics … not only contribute to poor-quality care for people with pain but also increase health-care costs.”

According to the CDC, physical therapy is particularly effective in addressing pain, and increasing function in cases of lower back pain, fibromyalgia and hip and knee osteoarthritis, and physical therapy can reduce or eliminate pain in patients recovering from surgery and battling cancer.

The need for alternative approaches to pain management is highlighted by recent statistics. In 2016, the latest year for which CDC data are available, more than 60 percent of drug overdoses in the United States involved an opioid, and overdose deaths from prescription opioids and heroin have increased fivefold since 1999, as patients addicted to prescription opioids increasingly turned to heroin when their access to prescription pills was limited. In 2016, 40 percent of the more than 42,000 opioid-related deaths were from prescription drugs, the CDC said.

According to the CDC, patients admitted to hospitals for opioid abuse are most likely to be white, male, ages 50-64 and Medicare beneficiaries with disabilities. Besides the risks of addiction and death from overdose, opioid users are more likely to experience increased sensitivity to pain, constipation, nausea, vomiting, dry mouth, confusion, depression, low testosterone, itching, and sweating.

Physical therapy can be used not only to manage chronic pain but to tackle one of its main risk factors – a sedentary lifestyle. Research has found a strong correlation between immobility and pain, and people who are overweight or obese are more susceptible to conditions such as lower back pain, headaches, fibromyalgia, and pelvic pain, according to the APTA’s PT in Motion.

The patient treatment plans designed by physical therapists provide a more customized approach to pain management than the reflexive prescribing of opioids, which treats patients the same way whether or not their painful conditions can be remedied.

These are some ways physical therapists can help patients address chronic pain and avoid opioid use, according to PT in Motion.

  • Exercise. Research has shown that people who exercise regularly experience less pain. Physical therapists develop exercise programs that improve cardiovascular fitness, muscle strength, and musculoskeletal imbalances to help ward off pain.
  • A review of five dozen randomized, controlled trials looking at physical therapy for adults with lower back pain found that treatment can decrease pain, improve function and help people return to work. Conversely, opioid use treats the pain without improving functionality.

    Similarly, research has shown that patients undergoing total hip arthroplasty experience less pain, shorter hospital stays, and improvements in function if they were on an exercise regimen before surgery. And physical therapy can reduce pain and improve physical function in patients with hip and knee osteoarthritis.

  • Manual therapy. Hands-on manipulation of joints and soft tissue can reduce pain, swelling, and inflammation and improve mobility. Research shows that manual therapy techniques are effective at reducing lower back pain, symptoms of carpal tunnel syndrome and other sources of pain.
  • • Sleep education. Pain often leads to sleep disturbances, which only exacerbates the problem. Studies show that sleep deprivation can increase sensitivity to stress and pain. Physical therapists can help educate patients regarding best practices for falling asleep and the importance of getting enough rest.

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