Spine Physical Therapy vs. Opioids: Get Past the Hurdles

Mobilization of the spine
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These days, the first thing many doctors do when a patient comes in with a back injury is to prescribe opioid pain relieving medication. Right off the bat. Called first line treatment, the use of this narcotic substance might be compared to a very stepped-up version of "take two and call me in the morning." 

Opioids are in the news regularly for the negative consequences that often result from taking them.

According to a 2017 study that was published in  the Journal of the American Board of Family Medicine, between 1999 and 2010, opioid sales quadrupled. The study authors also report that about every 36 minutes, someone dies from an overdose of opioids.

Opioids are also very often prescribed for chronic pain. But there's another, often more effective way to address your pain, if you're willing to do a little work. And that is spine physical therapy.

Now don't groan. There are a number of obstacles to switching from the comfort of a pill to a situation where you have to get to an appointment, learn new things, and do exercises at least once per day. So we're going to address them. Are you ready?

Make It to Your Spine Physical Therapy Appointment

One of the biggest obstacles to accessing the full amount of treatment that may be available to you has to do with making your way to an appointment in the first place.

For example, problems may arise if you live far away from the PT facility. While distance in itself can be a deterrent—who wants to drive 20, 30, 50 or more miles just to meet with an exercise taskmaster? If you don’t drive or have access to a car, it’s even worse.

Either way, it can be expensive. If you drive, you’ll pay for gas, and if you don’t, a round trip medical ride can cost $55 (for local transport in small cities) and up.

Some people take a bus, but that can be time consuming or pose an injury risk.

You may be pleasantly surprised at what you find if you research and ask around about transportation coverage, though. For example, Blue Cross Blue Shield in Michigan has one plan that pays the transportation costs for 36 medical visits per year.

Another potential place to turn is your local United Way. As a clearinghouse for resources, they may be able to point you to low or no cost transportation options. The United Way in your community may also have a fund you can tap into.

Scheduling Issues When You Go the Spine Physical Therapy Route

Another practical deterrent from taking the active approach to spine pain relief is being able to make appointments on the days, and at the times, that best suit you. Your insurance may pay for 3x per week sessions, or your doctor may recommend this frequency, but when you go to schedule, you find that, in reality, it’s impossible. There are simply not enough spots in the therapist’s schedule that match the openings in yours.

Or, you may be able to get appointments when you’d like, but doing so means you’ll have to see a therapist with whom you don’t enjoy much rapport. This may seem like a small detail, especially when you’re doing your best to get yourself scheduled, and on your way for the day, but working with a therapist with whom you feel connected can make a big difference.

A good working relationship with your spine physical therapist may well affect your motivation for doing your prescribed exercises at home, for keeping your appointments, and other things. This, in turn, will likely increase the benefits you get from making the time in your schedule and doing the work.

Here are a few tips on what to do when the scheduling aspect is just not working:

  1. Find out if the facility is open late on certain days of the week. Taking time during regular business hours from work to go to appointments can get old pretty quick, and you may sense that it’s affecting your job security, as well. Some offices do offer extended hours two or three days per week; others offer Saturday hours. It can’t hurt to ask!
  1. If that doesn’t pan out, inquire about other locations or satellite offices that may offer better hours.
  2. If all else fails, you might look for an entirely different office with which to do business. The American Physical Therapy Association reports that as of 2015, physical therapy services are self-referral (also known as “direct access”) in all 50 states, the District of Columbia and the U.S. Virgin Islands. That said, the types of treatments you can get from a PT without a doctor’s prescription may vary according to where you are (this is because state laws vary), so be mindful of that. What is self-referral? Basically it means you don’t need to wait for (or fight with) your doctor to write you a prescription before you can be seen. You can just call the office of your choice directly, and make the appointment. Many insurance companies will pay for direct access physical therapy sessions, but it’s a good idea to check first to be sure.

Can You Afford Spine Physical Therapy?

Along with these potential difficulties with physical therapy comes that old bugaboo—the costs. Unless you’ve been hiding your head in the sand, you know that medical treatment does not often come cheap. And spine physical therapy is no exception.

By the way, this may be true even if you have insurance. You may have a very high deductible (so that you or your employer can afford the premium), travel costs (mentioned above) may add to your payment woes, and you may need to get equipment such as a home TENS unit. These may or may not be reimbursable, depending on your exact situation.

One way to tame the costs of PT is to substitute some of the appointments with a personal trainer who has a specialization working with people in pain. A trainer may have a similar skill set to your therapist, but will likely also be open to working with her or him. Of course, you’d start with the therapist to get an evaluation, an initial home program and modalities. But after your routine is established, the right trainer may be able to take some of the responsibility for checking that you’re doing your exercises right, for advancing you and/or modifying the exercises, and for communicating back to your PT.

If you’re paying for everything out-of-pocket, costs of a trainer rather than a therapist may be less on a per session basis, and organizing your treatment this way may help offset any lack of coverage that affects you.

By the way, insurance companies generally limit the number of visits they’ll pay for which, in turn, may result in your getting discharged before you’re ready. Many people report that after 6 weeks of PT (the usual number of outpatient session that insurance companies grant) they’re out of danger but not out of the woods, so to speak. In other words, they’re still not 100 percent and/or they’d like to be more active, but because the effects of their injury linger a bit, they can’t.

If this is the case with you, again, working with a certified trainer may be of great benefit – by helping you complete your treatment, and get fully back in action. Certifications to look for include American Council on Exercise (ACE) and National Academy of Sports Medicine (NASM) personal trainer certifications. Before finalizing your decision on which trainer to go with, you might ask potential candidates about their experience working with injuries and pain.

Is Your Doctor in the Dark About Non-Drug Therapy for Spine Pain?

Believe it or not, many people, doctors included, are not well-informed about what kind of non-drug (and non-surgical) spine care options are out there, nor why these are valuable to patients such as yourself.

Unlike pain medication, physical therapy services generally are not advertised on national TV or radio. Combine that fact with the lack of understanding most people (again, doctors included in some cases) have about the nature of pain, and you’ve got a wall between you and a number of options that may be a lot easier on you in the long run.

Seeing a spine physical therapist is not just about getting rid of the pain; you’ve got to get your functionality back, plus learn lifestyle maneuvers and posture hacks that can keep you well without having to resort to a pill. To that end, you might consider challenging your doctor by asking her to explain how the risks of taking opioids compare with the risks of seeing a spine physical therapist.

If she can’t give you a satisfactory answer, an online resource you can check out is called Physiopedia. Physiopedia is a site run by student physical therapists from all over the world. It provides evidence based information on common orthopedic conditions and how they are treated, but it’s written so that non-medical people can understand.

Who knows? With a little research, you may even educate your doctor about the nature of pain, and how to replace the use of drugs to mask it with a more active approach such as spine physical therapy.

Opioids Are Not a Magic Cure

It’s entirely possible that your biggest barrier to pain relief without drugs is your own attitude. And as far as counterproductive attitudes go, the biggie here is the idea that opioids are a “magic pill” that makes the pain go away, and that they are all you need.

The problem is that opioids come with their own set of quandaries which, in the long run, can be much bigger than your back pain, including addiction.

Addiction (as if it weren’t bad enough on its own) is not the only potential complication of narcotic pain drugs. Many people experience severe constipation. Other possible side effects include dizziness, nausea, vomiting, physical dependence, and respiratory depression, according to a 2008 study published in the journal Pain Physician.

Most spine problems can be resolved or at least managed well without these problems when you actively participate in your treatment. This involves doing daily exercises, learning about good posture and biomechanics, and changing your lifestyle.

If it all this sounds like too much work, remember that pretty much everything in medicine is a trade-off between anticipated risks and benefits. The non-drug approach to feeling better will take more effort and time, but pain relief will likely come with better overall health and vitality, increased functionality, and fewer health complications down the road.

Source:

Becker, W., et. al. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. March 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359906/

Benyamin R., et. al. Opioid complications and side effects. Pain Physician. March 2008. https://www.ncbi.nlm.nih.gov/pubmed/18443635

Direct Access at the State Level. APTA website. June 2016.http://www.apta.org/StateIssues/DirectAccess/

Onishi, E. et. al. Comparison of Opioid Prescribing Patterns in the United States and Japan: Primary Care Physicians' Attitudes and Perceptions. Journal of the American Board of Family Medicine. May-June 2017. http://www.jabfm.org/content/30/2/248.full

Medicare Home. Blue Cross Blue Shield Blue Care Network of Michigan. http://www.bcbsm.com/medicare/help/faqs/getting-care/transportation-doctor-office.html

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