Role of Physical Therapy in the Opioid Epidemic
October 2019 is National Physical Therapy Month
Americans continue to misuse prescribed opioids at alarming rates. Physical therapy is a safe and effective alternative to opioids for treatment of chronic pain conditions.
The Opioid Epidemic: Things to Know
1.The CDC recommends nonopioid approaches for chronic pain.
In March 2016, CDC released guidelines urging clinicians to consider opioid therapy “only if expected benefits for both pain and function are anticipated to outweigh the risks to the patient.” Before prescribing opioids, providers are encouraged to check that nonopioid therapies have been tried and optimized. In cases when opioids are prescribed, providers are encouraged to “start low and go slow” with dosing and to combine with nondrug approaches like physical therapy. Cancer treatment, palliative care, end-of-life care, and certain acute care situations are cited as cases in which properly dosed opioid therapy may be appropriate.
2.The opioid epidemic doesn’t discriminate.
Virtually every age, gender, race, socioeconomic group, and community in the nation has been impacted by the opioid crisis. According to CDC, nearly 50 people die every day from overdoses involving prescription opioids. In 2017, the US Department of Health and Human Services declared the opioid epidemic a public health emergency.
The Role of PTs in the Treatment of Pain and Prevention of Chronic Pain
Acute pain typically comes on suddenly as a result of a specific incident such as surgery, a fracture, or trauma. Acute pain serves a useful biologic purpose and is self-limited. Chronic pain, on the other hand, serves no biologic purpose and has no recognizable endpoint. Chronic pain can be considered a disease state and can persist for months or years. When PTs work with patients in pain, they use tests and measures to determine the causes of that pain and to assess its intensity, quality, and temporal and physical characteristics.
Once the contributors to a patient’s pain are identified the PT designs an individualized treatment program combining the most appropriate techniques, including but not limited to exercise, manual therapy, and patient education to address the underlying problem.
• Exercise. Studies have shown that people who exercise regularly experience less pain. PTs develop, administer, modify, and progress exercise prescriptions and programs to address poor conditioning, impaired strength, musculoskeletal imbalances, or deficiencies that may lead to pain.
• Manual therapy. Manual therapy involves hands-on manipulation of joints and soft tissue to modulate pain, reduce swelling and inflammation, and improve mobility. Research shows that manual therapy techniques are effective at reducing low back pain, discomfort associated with carpal tunnel syndrome, and other sources of pain.
• Stress management. Interventions such as mindfulness, relaxation, visualization, and graded exposure to stress-producing events can help patients reduce pain and improve their functional capacities.
• Sleep hygiene. Individuals with persistent pain often complain of sleep disturbances. Evidence has shown that sleep deprivation can increase sensitivity levels and contribute to increased stress and pain. PTs can help educate patients regarding appropriate sleep hygiene to help combat the vicious cycle of persistent pain.
• Pain neuroscience education. Individuals who don’t understand the mechanisms and contributors to their pain may be more likely to seek pharmacological treatment for that pain. PTs can educate patients about modern pain science that highlights the processes involved in pain. The adage “know pain, know gain” can empower patients and provide hope and encouragement in their journey to overcome persistent pain.
The opioid epidemic is a complex problem that will be solved only through multidisciplinary collaboration, and individuals with chronic pain must be offered interventions that not only control pain but also address the causes of pain. The CDC, the American Society of Health System Pharmacists, and the American Physical Therapy Association, and other major health agencies and organizations all have affirmed that nonpharmacological and nonopioid therapy can be effective in managing chronic pain. It’s time for the health care system to look beyond opioids to options such as physical therapy interventions that treat pain and combat chronic pain by addressing its source.