PHYSICAL THERAPY
Last April, I wrote about physical therapy as an alternative to opioid use for pain control in orthopedic care. In that post which can found here, I discussed the benefits of physical therapy for pain management and identified ways a physical therapist can help control pain and improve function without a reliance on prescription opioid use.
Now for an update. Here are some of the most recent statistics for Rhode Island (1,2):
• In 2017, there were 324 accidental drug overdoses.
• In 2018, that number improved to 273.
• In 2017, Rhode Island had the tenth highest rate of drug overdose deaths in the United States.
• The number of overdose deaths related to Fentanyl has increased 15 fold since 2009.
• Males accounted for 79.1% of accidental drug overdoses.
• While all age groups are affected, in 2018, overdose deaths were highest in the 35-44 age group.
• Finally, a recent Washington Post investigation on the spread of fentanyl across the country identified Rhode Island as “ground zero” of the epidemic in early 2013.
Nationally, the statistics are still sobering (3):
• 11.4 million people misused prescription opioids in 2016
• Approximately 2.1 million people have an opioid use disorder.
• An estimated 130+ people die every day from opioid related drug overdoses.
• In 2016, about 400 prescribers had questionable opioid prescribing patterns for Medicare Part D beneficiaries at serious risk for opioid addiction.
While progress has been made over the last year controlling this pandemic, there is still considerable room for improvement. An estimated 116 million Americans continue to suffer with chronic pain. Unfortunately, prescription opiates remain a first line of defense in managing both acute and chronic pain. More recently, alternative pain management options have gained recognition and popularity as part of a multi-faceted strategy involving different patient care providers along the health care spectrum. In the center of this collaborative effort are physical therapists.
Physical Therapists are highly educated, licensed health care professionals with advanced training in anatomy, physiology and movement science. Merriam-Webster defines physical therapy as: “therapy for the preservation, enhancement or restoration of movement and physical function impaired or threatened by disease, injury or disability” (4).
Physical therapists engage in a comprehensive examination and evaluation process that focuses not only on pain and the symptoms associated with pain, but also the movement patterns, disorders and imbalances that contribute to painful conditions and movement. Through targeted and patient specific individualized treatment plans, physical therapists work to correct the causative factors contributing to pain and movement disorders. The end result; less pain and lower utilization of pain medication.
Clinical research has supported physical therapy as an essential non-pharmacological intervention in the management of pain. This can be achieved through a number of ways including education, exercise, manual therapy techniques and stress management. Last June, the American Physical Therapy Association released a white paper, “Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health”. That paper identified several scenarios where physical therapy can be effective in reducing pain and preventing chronic pain. For example (5,6):
Low Back Pain
A review of over 60 randomized controlled studies evaluating exercise therapy for adults with low back pain found that exercise treatment interventions reduce pain, improve function and help people return to their work.
Pre or Post Surgery
A review of 35 randomized controlled studies totaling nearly 3,000 patients undergoing total hip replacements found that preoperative education and exercise led to significant reductions in pain, shorter post op length of stays and improvements in function.
Arthritis
Studies have proven that therapeutic exercise programs can reduce pain and improve functional independence with daily activities in patients with advanced hip or knee osteoarthritis.
When should you choose Physical Therapy?
When the risks outweigh the rewards
Common side effects of opioid use include depression, addiction and overdose risk.
When you don’t want to mask the pain
Opioid use does little to address the issue causing your pain. Physical therapists can identify the issues causing your pain cycle and implement strategies and interventions to improve pain and function.
When your pain lasts more than 90 days
At this point, your pain is considered chronic and the potential use and abuse of opioids is high. Physical therapy is a non-opioid way to address the lingering issues that have been causing your chronic symptoms.
The opioid epidemic is a complex problem that requires multidisciplinary collaboration. Physical Therapists are uniquely positioned to contribute to the solution through an evidenced based non-pharmacologic treatment approach. Given the statistics and risks associated with opioid use, consider asking your doctor for a referral to a physical therapist first before considering opioids.
