How Physical Therapy Can Help Fight the Opioid Epidemic

Physical therapist working with client at gym
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Can physical therapists and the PT profession be a positive force to help solve our nation's addiction to opiate medication?

Opioid use has become a serious problem in the U.S. The United States consumes 99% of the world's hydrocodone, the number one opioid pain medication. Doctors prescribe enough opioids each year to give five pills to every citizen. So we should all be feeling good, right?

Wrong. While the number of people consuming pain medication has increased, reported pain has not changed. Plus, there are some potentially serious downsides to using opioid medication for controlling non-cancerous, musculoskeletal pain.

Facts About Opioid Medication Use

When OxyContin came about, a name brand extended-release opioid pain medication first developed by Purdue Pharma in the mid-1990s, it was touted as a safe way to manage pain. Doctors were told that the medicine was not habit-forming and that the side effects of using the medicine were minimal. It turns out, the opposite is true.

Opioid medicines are habit-forming, and they can lead to some serious and dangerous consequences, including dependency and overdose.

The Centers for Disease Control and Prevention (CDC) has listed a few specific facts about the opioid epidemic. Some statistics about American opioid use (and abuse) includes:

  • From 1999 to 2013, the number of opioid medications dispensed has quadrupled.
  • Deaths related to opioid addiction have quadrupled since 1999.
  • Approximately two million Americans were addicted to opioid pain medication in 2014.
  • Opioid addiction can lead to the abuse of other illicit drugs.
  • Approximately one in four patients receiving long-term opioid therapy in the primary care setting may be struggling with addiction.

So there is a big problem with opioid medication, but isn't it a useful and effective way to manage pain?

It can be, but only under the careful supervision of your doctor. Non-musculoskeletal pain, like the kind that may occur with some cancerous tumors, may respond quite well to opioid medication, allowing the patient to function fully in their day-to-day life. 

Certain patients with chronic pain can effectively manage their pain with opioid medicine, but this needs to be closely monitored by their doctor.

There are some downsides to using a highly-addictive opioid pain medicine that must be addressed.

Addressing the Problem of Opioid Use

In August 2016, the United States Surgeon General Vivek Murthy, MD sent a letter to physicians addressing the problem of opioid addiction and asking that all healthcare practitioners work together to combat this epidemic of opioid abuse and addiction. The letter offers a three-step plan to fighting the epidemic:

  1. Education about thow to treat pain safely and effectively
  2. Screening of patients for possible opioid use disorders and connecting those patients with the best evidence-based treatments
  3. Starting to treat opioid abuse as a chronic mental illness and not a "moral failure"

Recommendations adapted from the CDC guidelines list exercise and physical therapy as a mode of treatment to be considered prior to prescribing habit-forming prescription medication.

How Can Physical Therapy Help?

Physical therapists have the unique opportunity to work closely with patients who are hurting. Most people show up to the physical therapy clinic because they are in pain and are not moving well. The goal for those patients is to improve mobility while decreasing pain. 

Your physical therapist can assess your particular situation and give you strategies to help manage your pain and improve your ability to move and function optimally, without the need for habit-forming pain medication.

Studies show that engaging in an active physical therapy program can help improve your pain and mobility. Your physical therapist can also show you strategies to help keep your pain away. Some different methods and treatments that your physical therapist may use include:

  • Exercise: Movement and exercise have been proven to be effective for most musculoskeletal conditions, and your physical therapist is a movement expert who can show you what to do. Exercise should be your main tool in decreasing pain and taking an active role in your pain treatment.
  • Electrical stimulation and TENS: Electrical stimulation, or E-stim, can alter the sensations that you are feeling to decrease your pain. The stimulation has little side effects, and it can be used just about anywhere.
  • Iontophoresis: This form of electrical stimulation can administer anti-inflammatory medication through your skin to manage your pain.
  • Heat or cold: Hot packs and cold packs may be used to decrease pain and alter local circulation to manage inflammation.
  • Postural correction strategies: Sitting with poor posture may be causing your pain, and learning strategies to change your posture may be necessary.
  • Kinesiology taping: Although there is limited research regarding the efficacy of kinesiology tape, it may be used to manage your pain. (Plus, there are very few side effects to using K-tape.)
  • Massage: Soft tissue massage can relax muscles and muscular spasm and can help decrease pain that you are feeling.

Some of these approaches—like TENS, heat, or massage—are passive treatments; you do nothing while your physical therapist applies the treatment to you.

Although these may be helpful, it is generally recommended that you engage in an active physical therapy rehab program to treat your musculoskeletal condition and pain. This includes exercise, which can help you gain strength, range of motion, and functional mobility. Plus, you may just have some fun while doing while working with your physical therapist, and you may find your energy and motivation levels increase with exercise.

And guess what? There are very few long term negative side effects to engaging in physical therapy. Your muscles may be a little sore temporarily, but the long-term benefits can be worth it.

What Should You Do?

If you develop musculoskeletal pain, like neck pain or a rotator cuff strain, choose to see a physical therapist first. In many cases, you can visit a physical therapist via direct access, and you can get started on the road to recovery right away. Your PT can assess your condition and refer you to a specialist if necessary, but many times your condition can be managed in the PT clinic.

If your doctor prescribes opioid pain medication for your musculoskeletal condition, inquire about starting physical therapy—a more natural treatment for pain—rather than taking medicine. Ask about the side effects of the medicine that your doctor prescribes. Other questions you might ask include:

  • Can you become addicted?
  • What is the plan to get you off the medication?
  • What is the long-term plan for safely managing your pain? 

You are in control of your healthcare, and understanding the dangers of opioid medication use can help you make the best decisions for your pain management strategy.

If you are abusing opioid pain medication, don't be afraid or embarrassed to seek help right now. The right healthcare professionals can help you safely manage your problem and can get you on the road to recovery.

Opioid pain medication has its place in medicine. It can be effective for managing certain types of pain. Unfortunately, the risks of using—and potentially abusing—opioid medicine are real.

You have a choice. If you develop musculoskeletal, non-cancerous related pain, you can choose to visit your physical therapist first. Your PT can work with you and your doctor to safely and effectively manage your pain and improve your overall functional mobility, so you can quickly return to your normal, pain-free lifestyle.

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