America is in the midst of an opioid epidemic. Sales of prescription opioids have nearly quadrupled since 1999. According to the Centers for Disease Control and Prevention, in 2012 alone enough opioid prescriptions were written for “every American adult to have their own bottle of pills.”
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, through its national #ChoosePT campaign, 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, when:
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 on the #ChoosePT campaign, including a pain self-assessment that patients can use to facilitate conversations about their care, is available at MoveForwardPT.com/ChoosePT.