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Physical therapy can create a path for reduced opioid use

Opioid abuse is a widely recognized public health crisis in the United States and the […]

Opioid abuse is a widely recognized public health crisis in the United States and the detrimental effects are wide-ranging and severe. Individuals in pain, especially chronic pain, are more likely to use opioids.

The coronavirus pandemic (Covid-19) has the potential to exacerbate opioid and other drug use. Research suggests that opioid use can worsen pain and induce mood disorders, such as anxiety and depression, over time. The disruption to daily life, and the resulting economic decline due to Covid-19 has the potential to cause an increase in opioid use.

In fact, a recent study cited in the Washington Post found that suspected overdoses for all drugs, not just opioids, jumped 18 percent in March 2020 compared with last year, 29 percent in April and 42 percent in May, according to the Overdose Detection Mapping Application Program, a federal initiative that collects data from ambulance teams, hospitals and police.

This catch-22 between chronic pain and mental health issues illuminates one reason why opioids should be prescribed with caution.

Opioid use that exacerbates chronic pain is known as Opioid-Induced Hyperalgesia (OIH). While the exact mechanisms of OIH are still being researched, it is generally accepted that the prolonged use of opioids has the potential to decrease the body’s ability to deal with pain naturally and increases the sensitivity of pain receptors in the body. This creates a scenario where opioid use must increase to create the same level of pain relief, creating a bidirectional recipe for increases in opioid use.

But it doesn’t have to be that way.

Physical Therapy (PT) can create a path for reduced opioid use.PT has been shown to be effective at controlling pain and decreasing opioid use by increasing muscular strength through therapeutic exercise. Studies have shown that there is a direct association between increased muscular strength and decreased pain. Similarly, and equally important, exercise can decrease an individual’s perception of pain.

Physical Therapists are highly qualified in prescribing and teaching appropriate exercises for the patients they treat. They are also experts at educating patients on proper movement patterns and body mechanics, thereby decreasing pain and reducing the risk of injury.

Effective PT treatment involves understanding the patient’s thoughts and fears related to their pain response. Knowledge of the patient’s mental state allows the Physical Therapist to use appropriate manual therapy and introduce therapeutic exercise and activity at the most opportune time. Understanding the patient’s pain response allows the Physical Therapist to better educate the patient, which is their most important role in treating patients in pain.

Because Physical Therapists generally spend more time with patients than other healthcare professionals, this allows them to develop a trusting relationship which can facilitate healing. Once this trust is established, the Physical Therapist can educate the patient about PT options for pain control. This is especially important when treating chronic pain patients, who may have “been through the system” and have a difficult time trusting health care professionals. There is promising research that indicates that if patients with pain are educated on the cause of their pain in a manner in which they understand, they experience less anxiety about movement and about their pain in general.

Physicians with chronic pain patients in their care should strongly consider educating themselves on the various non-pharmacologic methods currently available for treating chronic pain, such as PT. In general, education on pain management is sorely lacking in medical school, and many physicians report feeling underprepared when dealing with chronic pain patients and opioid management.

When interacting with new patients presenting with pain, physicians should listen carefully and empathetically to the patient, and should be aware of any signs of pain catastrophization, such as excessive rumination on pain and feelings of helplessness when in pain. Patients who exhibit such signs have been shown to be at a higher risk for prescription opioid misuse and would benefit from thorough pain education delivered by a qualified healthcare professional.

Insurers and physician groups should be aware, recognize, and take seriously the responsibility that they have in combating the opioid epidemic. These entities play an important role in the healthcare ecosystem due to their ability to choose what forms of treatment to authorize. Policymakers in this realm should educate themselves on current best practices for chronic pain management, such as recent CDC guidelines stating that non-opioid pharmacologic treatment and non-pharmacologic treatment are preferred for chronic pain, and reimburse for services accordingly.

And finally, patients with chronic pain should be encouraged to take an active role in their recovery. Research has shown that patients who advocate for themselves and collaborate on their care enjoy better outcomes. Patients with chronic pain, like physicians and other health care providers, should do their best to educate themselves about their condition and on the full biopsychosocial spectrum of treatments available.

While it can be difficult to stay active when experiencing pain, patients should consider consulting a movement professional, such as a Physical Therapist, to find ways that they can get moving safely and without increasing pain.

Photo: Stuart Ritchie, Getty Images


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Francis Stenek

Francis Stenek is a Clinical Consultant for Bardavon Health Innovations, with more than eight years of experience working as a PTA in a variety of clinical settings including inpatient rehabilitation, pediatrics, aquatic therapy, and outpatient orthopedics/sports medicine. As a PTA, he has also served as a Clinical Instructor for PTA students.

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