Anyone who takes opioids is at an alarming risk of developing an addiction. Since 2010, we have been amid an Opioid Epidemic. One thing you have likely not heard is that physical therapy can be an alternative solution before opioid use. However, before discussing solutions, it’s essential to understand the problem.
Statistics on Opioid Prescriptions
- There were 58 opioid prescriptions written for every 100 Americans. Although this is a slightly declining trend from years prior, the overall strength of these medicines is increasing. Therefore, there is a flat trend when measuring morphine milligram equivalents (MMEs) prescriptions.
- In 2019, there were over 70,000 drug overdose deaths in America; over 70% of these deaths were from either prescription or illicit opioids.
- 80% of all heroin users first use prescription opioids.
- The total economic burden of prescription opioid misuse in the U.S. is estimated at $78.5 billion annually.
These numbers are staggering and should make us all realize that if we are not directly affected, we are at least indirectly affected.
Acute Pain vs. Chronic Pain
Now for the good news: opioids are effective and safe for acute pain over short durations. There is a difference between acute pain and chronic pain. Acute pain results from tissue destruction – like a broken leg or pain felt immediately after surgery. Conversely, chronic pain results from changes in nervous sensitivity to a condition after a more extended time.
Treatments for Chronic Pain
Chronic pain usually does not respond well to opioids, but it does to movement and exercise — two things physical therapy is known to improve. First, chronic pain tends to decrease the pain threshold. This does not mean that we become “less tough,” as this is a physical phenomenon. Exercise tends to improve this threshold. In a post on WebMD, Gina Shaw showed that people who exercised were better able to manage their pain than those who did not exercise.
Additionally, in the 2008 Nord-Trondelov study, there were significantly fewer musculoskeletal complaints about those who exercised regularly versus those who did not in an 11-year follow-up. In “Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health,” the author notes that chronic pain is best managed when the specific pain characteristics, pain intensity, and other risk factors are taken into account. Therefore, physical therapy is uniquely tailored to do just that.
Physical Therapy for Pain
A 2019 study analyzed 200,000 commercial and Medicare Advantage insurance beneficiaries seeking treatment for low back pain. It found that those whose initial referral was with a physical therapist, chiropractor, or acupuncturist compared with those whose index visit was with a primary care provider decreased odds of early opioid use by 85%-91% and lowered low-term opioid use by 73%-78%.
As physical therapists, we make sure that we assess the type of pain you have as well as the intensity of the pain. We consider what you can and cannot do because of pain and look at what you want to do if the pain is not stopping you. We can then devise an exercise and movement plan to address each aspect. Ambrose and Golightly found in a 2016 study that pain was most reduced when the exercise program was tailored individually, progressed slowly, and considered physical limitations, psychological needs, and available resources. This is the definition of what we do as physical therapists.
The evidence is vital for physical therapy, and the consequences are so significant for overprescribing opioids that the CDC is now recommending non-opioid treatment of chronic pain and a big push for physical therapy.
Pain, specifically chronic pain, is a big problem for the individual and society. There is an alternative to medication that can cause effects worse than pain. Movement, exercise, and physical therapy can help lessen pain. Pain, specifically chronic pain, is not at the mercy of prescription opioids. Physical therapy can answer chronic pain without the dangers of opioids. Think movement and not medicine to gain control over how you are managing your pain. Request an appointment with us, and we’ll help you get back to the things you love.
Sources:
cdc.gov: August 2018
National Institutes of Health, drugabuse.gov: March 2018
Shaw, Gina: WebMD 2018
Nord-Trondelov: BMC Musculoskeletal Discord: 2008
Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health: APTA, moveforwardpt.com: 2018
Ambrose, KA; Golightly, YM, Physical Exercise as Non-Phamalogical Treatment of Chronic Pain. Best Practices RES. Clinical Pharmacology. February 2017
