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 medication.

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.