America is in the midst of an opioid epidemic. Sales of prescription
opioids have nearly quadrupled since 1999. Prescription opioids —
medications that reduce pain by interrupting pain signals to the brain —
only mask the sensation of pain, and they come with side effects
including depression, overdose, and addiction, plus withdrawal symptoms
when stopping opioid use. Pain relief doesn’t have to come in a bottle,
however. Physical therapists can provide a safe, drug-free alternative
for treating pain.
When to choose physical therapy
In March 2016, the CDC released guidelines urging prescribers to rely
less on opioids in favor of non-drug alternatives. The guidelines
recognize that prescription opioids are appropriate in certain cases,
including cancer treatment, palliative care, and end-of-life care, but
for most long-term pain management non-opioid approaches are
recommended.
The American Physical Therapy Association is reminding patients that
they have the right to choose their method of pain treatment. Physical
therapists treat pain through movement and patients get to play an
active role in their recovery.
Based on the CDC guidelines, patients should choose non-opioid alternatives, such as physical therapy, in the following cases:
The risks of opioid use outweigh the rewards. “Experts
agreed that opioids should not be considered first-line or routine
therapy for chronic pain,” according to the CDC. “Given the substantial
evidence gaps on opioids, uncertain benefits of long-term use, and
potential for serious harm, patient education and discussion before
starting opioid therapy are critical so that patient preferences and
values can be understood and used to inform clinical decisions.”
Physical therapists can play a valuable role in the patient education
process, including setting realistic expectations for recovery with or
without opioids. As the guidelines note, even in cases when evidence on
the long-term benefits of non-opioid therapies is limited, “risks are
much lower” with non-opioid treatment plans.
Pain or function problems are related to low-back pain, hip or knee osteoarthritis, or fibromyalgia. The
CDC cited “high-quality evidence” supporting exercise as part of a
physical therapy treatment plan for those familiar conditions.
Opioids are prescribed for pain. Even in situations
when opioids are prescribed, the CDC recommends that patients should
receive “the lowest effective dosage” and opioids “should be combined”
with non-opioid therapies, such as physical therapy. Clinicians should
continue opioid therapy only if there is “meaningful improvement in pain
and function that outweighs risks to patient safety.”
Pain lasts 90 days. At this point, the pain is considered “chronic” and
the risks for continued opioid use increase. An estimated 116 million
Americans are living with chronic pain, but the danger of masking pain
with prescription opioids is clear. More than 165,000 people in the
United States have died from opioid pain medication-related overdoses
since 1999, and every day more than 1,000 people are treated in
emergency departments for misusing prescription opioids.
If you or a loved one needs help managing pain, talk with your
health care provider about safe alternatives to opioids. Additional
information, including a pain self-assessment that patients can use to
facilitate conversations about their care, is available at MoveForwardPT.com/ChoosePT.
Source: American Physical Therapy Association