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?

We have a huge problem in this country. It seems that over the past 20 years, we have created a society of people who feel it is their right to not feel any pain. Our solution? Hand out opioid pain medication like it is candy. In fact, the United States consumes 99 percent of the world's hydrocodone, the number one opioid pain medication.

Doctors prescribe enough opioids each year to give 5 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 down sides to using opioid medication for controlling non-cancerous, musculoskeletal pain, such as when you have a condition like a strain, fracture, or after surgery.

Facts About Opioid Medication Use

When OxyContin, a name brand opioid pain medication was 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, as we have seen, that these medicines are habit forming, and they can lead to some serious and dangerous consequences, with an increased risk of drug dependency or overdose.

The Centers for Disease Control and Prevention (CDC) has listed a few specific facts about the opioid epidemic. Understanding that negative effects of opioid medication can help realize the benefits that physical therapists can bring to the table when managing this 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 2 million Americans were addicted to opioid pain medication in 2014.
  • Opioid addiction can lead to abuse of other illicit drugs.
  • Approximately one in four opioid users struggles with addiction.
  • People who struggle with opioid addiction are 40 times more likely to be addicted to heroin.

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. 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 the proper prescribing of opioids
  2. Screening of patients for possible opioid use disorders and connecting those patients with the best treatment
  3. Starting to treat opioid abuse as a mental illness and not a "moral failure"

The Surgeon General also has made recommendations for prescribing opioid medication. These 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.
  • Electrical stimulation and TENS: Electrical stimulation, or E-stim, can alter the sensations that you are feeling to decrease your pain.
  • 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 use 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 items—like TENS, heat, or massage—are passive treatments; you do nothing while your physical therapist applies the treatment to you. Passive treatments should not be your first choice of pain relief therapy since it can cause you to become dependent on your PT to apply the treatment. They are listed above since they are treatments that you may be exposed to while attending physical therapy for your painful condition.

It is 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 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 side effects of the medicine that your doctor prescribes. Can you become addicted? 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 and abuse can help you make the best decisions for your pain management strategy.

If you are abusing opioid pain medication, seek help. The right healthcare professional 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 chronic 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, 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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