Try as we might, it’s nearly impossible to avoid all pain in our lives. Whether it’s twisted ankle or a bad back, we all experience some pain at one point or another, which is why the presence of pain is by far the most common reason people seek out health care. But treating pain, especially chronic pain lasting for more than three months, is not always an easy or straightforward matter. Treatment often requires a multifaceted approach that includes a number of different components due to the many variables that contribute to a patient’s perception of pain and their response to treatment.
Opioids are natural and synthetic drugs that are commonly prescribed for pain. Some patients, such as those with cancer or other serious illnesses, and those who are on end-of-life care, may require opioids due to the extreme amount of pain they are in. Opioids may also be appropriate for a limited period of time for certain short-lived (acute) painful conditions; however, it’s not clear if they are also effective for patients with chronic pain. But this has not stopped medical professionals from prescribing these drugs to address all types of conditions.
Since the late ‘80s and early ‘90s, opioids have been prescribed on a grand scale to individuals dealing with both acute and chronic pain. Over the years, prescribing these drugs has become a standard practice that many doctors assumed was safe and effective, even though there has always been a lack of high-quality research on the benefits and harms of opioids. As a result, opioids have been overprescribed for far too long, as at least 400,000 people have died of an opioid overdose between 1999-2017.
The epidemic has brought light to the situation and raised questions about prescribing these drugs to patients dealing with pain, and professional organizations like the CDC have provided guidelines as to when and how to give prescription, and what to do to address this problem. One of the central messages that has been stressed by healthcare leaders in various positions is that physical therapy should be utilized as a first-line treatment and an alternative to opioids for managing pain. Here are some examples:
- In August of 2016, the U.S. Surgeon General at the time, Vivek Murthy, MD sent a letter to 2.3 million medical professionals to address the opioid epidemic provide a call to action to end it. The letter was combined with an infographic to assist these professionals in the prescription of opioids, and one of the central recommendations made was to consider non-opioid therapies first, with physical therapy being listed as an important alternative.
- The current U.S. Surgeon General Jerome Adams, MD spoke at an event hosted by the American Physical Therapy Association (APTA) this past January, during which he focused on the opioid crisis and the role of physical therapy in addressing it. He highlighted the essential role that physical therapists can play by offering pain-relieving services to patients, and stressed the importance of educating these individuals on a national scale.
- A task force made up of experts in various medical fields was created in 2018 in order to establish guidelines for managing pain and the role of opioids in the process. One of the key guidelines was that restorative therapies like physical therapy should be a central component of patient care. It points out that these therapies play a significant role in managing acute and chronic pain, and that positive patient outcomes are more likely when they are used.
There are many reasons why physical therapy has become recognized as such an effective alternative to opioids. Narcotics like opioids are only meant to decrease someone’s perception or sensation of pain, and they are not intended to actually address the issues that are causing it. This is why opioids are only supposed to be used temporarily until the pain subsides. Physical therapy, on the other hand, is not a temporary solution. Instead, it focuses on identifying the origin of the pain, and then creates a personalized treatment program designed to alleviate it permanently.
The benefits of physical therapy and its power to help patients avoid opioids have also been highlighted in a number of recent research studies. One study investigated whether seeing a physical therapist early for low back pain had an impact on the amount of healthcare each patient used and if they received an opioid prescription. The results showed that early physical therapy reduced healthcare utilization and costs, and also lowered the rates of opioid use, which may improve the efficiency of healthcare.
But despite the many signs that physical therapy is a much smarter and safer solution to pain than opioids, there is still a ways to go in changing how doctors manage patients in pain. In another study that reviewed data on patients with low back pain over 14 years, it was found that doctors only referred about 10% of patients to physical therapy, and this rate remained low through the entire period of time. The number of doctor visits that led to an opioid prescription, however, increased during this time in this same population.
This shows that while it’s important for medical professionals to do their part by prescribing opioids only when they are absolutely necessary and for short periods of time, patients must realize that they also have a choice in this matter. Seeing a physical therapist first will help you get on the path to an active and self-directed approach to pain, which focuses on patient participation to yield the best possible results. This approach to care also comes without the side effects and serious risks associated with an opioid prescription, meaning patients can be more confident that their treatment will help them improve while avoiding the dangers of these medications.
