Physical therapy and the opioid epidemic
Jeff Simmerman, P.T.
Marcus Daly Rehabilitation Services
1200 Westwood Drive
Hamilton, MT 59840
Physical therapy and the opioid epidemic
The United States Surgeon General wrote a letter to all physicians August
of 2016 with the opening line, "I am asking for your help to solve
an urgent health crisis facing America: the opioid epidemic." Opioids
are types of drugs that help with pain relief when over-the- counter medication
is not sufficient. In 2012, 259 million prescriptions for opioids were
written in this country. Interestingly, 60% of adults prescribed opioids
report leftover pills. However, while it is human nature to avoid discomfort,
many of these pain-relieving medications have an inherent risk of addiction.
The letter goes on to review the history of significant events that paved
the way for our current state of affairs with opioid addiction and the
challenges before the health-care community. Finally the letter concludes
with encouragement for physicians to learn about what treats pain effectively,
screen patients for opioid disorders with recommendations for evidence-based
intervention and lastly discussing addiction as a disease and not a moral
failing. The current school of thought is that a more judicious approach
to prescribing opioid medication for long-term pain will require varied
non-opioid therapies to help. The Centers for Disease Control and Prevention
issued guidelines to assist in this process. Physical therapy and exercise
are listed as an appropriate response to try prior to prescribing opioid
How can physical therapy and exercise help reduce long-term pain? Opioids
action masks the pain whereas physical therapy treats the source of pain
through movement. The American Physical Therapy Association website quotes
a study of 20,000 people over an 11 year timespan who exercise on a regular
basis experience less pain. The "exerciser" group also has a
28% reduction in chronic widespread pain. A physical therapist is adept
at prescribing exercise that best addresses your needs and goals. Physical
therapists use manual therapy techniques to reduce pain. Various approaches
include soft tissue mobilization, strain and counter-strain positioning,
dry-needling, and manipulation.
Research indicates good results with these hands-on modalities. Additionally,
education is an important tool used to combat pain. Military personnel
who listened to a 45 minute lecture on low back pain from a physical therapist
were less likely to pursue treatment as compared to peers that did not
receive the information. However, the unfortunate and inconvenient statistics
regarding the incidence of low back pain indicate that nearly 80% of the
general population will experience low back pain in their lifetime and
that 20-30% of the general population has low back pain at any given time.
Clearly, as America combats an opioid epidemic, more non-opioid interventions
that are safer and effective at reducing pain are needed. Finally, your
physical therapist will utilize a positive therapeutic relationship to
best work with you and the special requirements of your painful condition.
Recent studies indicate that if you invest your time, interest and energy
in your rehabilitation, it will yield better results. The physical therapist
is especially suited to create a comprehensive plan while assessing your
pain response to various interventions.
A group of physical therapists were recently reviewing the multifaceted
nature of low back pain when the instructor stated, "complex problems
demand complex solutions". Interestingly, and unfortunately the instructor
is correct. While many industries have attempted to treat low back pain
through many varied home remedies, most of these "treatments"
have only yielded limited positive results. Because of the high frequency
of low back pain, (most of us experience this pain at some point in our
lives) many individuals who have previously suffered from low back pain
may express what worked for them. Unfortunately, what we have learned
in recent decades in spine research is that each person must be treated
individually. Therefore, it is quite difficult to create a general home
program that can address the varied needs of many individuals with low
back pain. Each case is different and will require specific and individualized
treatment. Apparently, no easy solutions exist.
Is there any way to avoid chronic pain? The American Physical Therapy
Association presents 5 methods at reducing your risk of developing chronic
pain. First, understand your pain. Evidence suggests that the more you
understand the nervous system and how it works can aid in reducing the
risk of developing chronic symptoms. Even a basic understanding can be
helpful. Second, keep moving albeit slowly while gradually increasing
intensity. Our bodies were built to move and may do poorly when not given
the opportunity. Next, if you experience an injury, consider spending
time with a physical therapist. Your PT is available to answer your questions
and create a comprehensive program that best addresses your needs. Fourth,
don't focus on your medical diagnostic imaging. It is common for the
health-care consumer to want the special test to reveal "why we hurt";
however, many times the image does not provide all of the information.
This is most evident in treating complicated spine pain.
However, once imaging has cleared you of a serious medical condition,
a physical therapist will aid in returning you to your typical function.
Lastly, studies suggest that addressing depression and anxiety will also
help in reducing your risk of developing chronic pain. Talk with your
health-care provider about your mental health throughout your current
episode of care.
However, should you ever use opioids or opiates? That is a medical issue
that involves both you and your physician. Physicians appropriately prescribe
these medications regularly as part of a medical plan of care. However,
please consider consulting your physician when prescribed medication for
long-term pain reducing affects. The Centers for Disease Control and Prevention
guidelines have placed physical therapy and exercise as a first-line defense
in treating pain and should be considered prior to prescribing opioid
medications. Through prescribed exercise, manual therapy, education, and
a positive therapeutic relationship, physical therapy is an alternate
choice in addressing the complicated nature of long-term pain.
Questions and or comments regarding this week's health column please
contact, Marcus Daly Rehabilitation Center and Services, a service of
Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840.