Physical Therapy vs. Opioids: Which is the Road Best Taken? by Shawn Cray, DPT, CSCS

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The 16th century philosopher Francis Bacon once observed that on many occasions “the remedy is worse than the disease.” And this would seem to be the case, at least when it comes to prescribing narcotics to treat injuries. Only to discover that the “cure” has surpassed the pain it was supposed to treat and becomes a major problem unto itself.
In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The CDC recognizes that prescription opioids are appropriate in certain cases, including cancer treatment and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends non-opioid approaches including physical therapy, particularly whereas:

  • The risks of opioid use outweigh the rewards. Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms.  Because of these risks, experts agreed that opioids should not be considered first line or routine therapy for chronic pain.
  • Patients want to do more than mask the pain. Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
  • Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia. The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
  • Opioids are prescribed for pain.  Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with non-opioid therapies, such as physical therapy. Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for non-opioid treatment.

Physical therapists are uniquely situated within the healthcare system to see patients with a frequency rarely encountered elsewhere. This allows for an emphasis on teamwork and quality one-on-one interactions between the physical therapist and patient. It’s as simple as night and day; Opioids mask pain, physical therapy is designed to cure pain. It doesn’t always work, but there’s more upside than downside. The upside is eventually to be able to live a productive, pain-free life. The downside needs no explanation.

Another factor that often comes into play is that time is not always on the side of the patient. In the case of an injury caused by a vehicle accident, there sometimes can be a three-week gap between an accident and getting the insurance red-tape untangled. During that time the injured party is still in pain and may be looking for a quick fix, which doctors are often willing to accommodate. Feel a pain, take a pill. It’s like the medical version of Pavlov’s dog.
Still, doctors aren’t the villain here. Besides being busy and over-worked they are doing what they have been trained to do. To ease suffering. Yet according to the American Society of Anesthesiologists, “A physical therapist that specializes in physical medicine and rehabilitation may be able to create an exercise program that helps improve the ability to function and decrease pain.” This means, if a physical therapist can get involved in the process quicker, they may be able to offer alternatives. Earlier intervention could be the key. Especially as doctors are often specialists in a particular area of the body, whereas a physical therapist looks at the body as a whole.

Our industry isn’t perfect. There are lazy doctors, accountants,  lawyers and certainly, lazy physical therapists. The key is to do your due diligence. The time spent doing that, and the prospect of finding a PT that has the tools needed to understand pain and will work to put the pieces of the patients life back together, will certainly outweigh a very scary alternative. Fortunately, even the medical profession appears to be coming around to the idea that there may be an alternative to fast-tracking narcotics as the answer to injuries.

“Exercise, physical therapy, and talk therapy have proven benefits in the areas of making the body work better, and coping. Health care providers ought to approach long-term pain with a combination of those treatments,” says Ellen Edens, MD, a psychiatrist who treats veterans with chronic pain and long-term opioid use in the VA Connecticut Healthcare System. “An opiate might bring your pain score down from an 8 to a 6.5, but if we add physical therapy, we can bring you down to a 6,” Edens says. “Ibuprofen might bring you down to 5.75. Then we’re going to get you therapy for your depression and your mood. Then acupuncture will bring you down to 5.25 and so on.”

It’s a sad state of affairs that something as basic as a lower back injury from lifting boxes in a warehouse, or a shoulder pain caused by washing your living room windows, can be a GPS leading directly down a road to potential opioid addiction. Perhaps now is the time to seek an alternative route.

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