Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report."

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends nonopioid approaches including physical therapy.

Patients should choose physical therapy when ...

• ... The risks of opioid use outweigh the rewards.
  Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. 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.
• ... Patients want to do more than mask the pain.
  Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
• ... Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
  The CDC cites "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 nonopioid therapies, such as physical therapy.
• ... 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 have chronic pain each year. The CDC guidelines note that nonopioid therapies are "preferred" for chronic pain and that "clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

"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," the CDC states.

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

Physical Therapy Journal (PTJ) Special Issue Highlights Effectiveness of Nonopioid Approaches to Pain

ALEXANDRIA, VA, April 16, 2018 — Early utilization of physical therapist treatment can reduce opioid use and downstream health care costs. That's just one important takeaway from the latest edition of Physical Therapy (PTJ), the official scientific journal of the American Physical Therapy Association (APTA), which today published a special issue devoted to nonpharmacological pain management. 

In five original research papers released online ahead of print for the May special issue:

• Patients who received physical therapist treatment immediately following arthroscopic hip surgery were associated with lower downstream costs and lower opioid use.
• People treated by a physical therapist within three days of the onset of low back pain were associated with lower total health care costs and lower opioid use.
• Telehealth physical activity programs for older adults with low back pain improved physical function.
• Analysis of patient screening suggested it may be possible to predict which patients are at risk for long-standing musculoskeletal pain.
• Patient education about pain's link to the brain improved the participation of patients with chronic spinal pain in beneficial physical activity programs.

"This special issue adds new evidence to a growing body of evidence on the important role of nonpharmacological interventions for the management of chronic pain," said Editor in Chief Alan M. Jette, PT, PhD. "The need for this information has never been so urgent."

According to the American Academy of Pain Medicine, 100 million Americans live with chronic pain, and many of them turn to opioids to manage it. The Centers for Disease Control and Prevention (CDC) recommends pursuing nonopioid options like physical therapy for the safe management of chronic pain. Physical therapists treat pain through prescribed movement and exercise, hands-on care and patient education.

APTA's #ChoosePT campaign raises awareness about the risk of opioids for long-term pain management and physical therapy as a safe and effective alternative, consistent with CDC guidelines.

The American Physical Therapy Association represents more than 100,000 physical therapists, physical therapist assistants and students of physical therapy nationwide. Visit MoveForwardPT.com to learn more about the types of conditions physical therapists treat, and find a physical therapist in your area.

Source: APTA