By: Dr. Donald Dare
As awareness to the nation’s opioid epidemic continues to gain attention, health care professionals are rethinking how to go about treating long-term pain; and thanks to significant research in recent years, we now understand that chronic pain is complex and varied, so it can neither be easily diagnosed nor solved. As such, doctors must balance a patient’s symptoms with medical analysis, weighing the risks and potential benefits of different treatments.
The most innovative health care providers are transforming singular models of care (like prescription medications) into hybrids that bring together experts such as physical therapists, behavioral health therapists and health coaches with primary care physicians to offer alternatives beyond prescription painkillers.
Treatments like physical therapy, chiropractic, acupuncture, and cognitive behavioral therapy—including relaxation training, guided exercise and biofeedback – are recognized by the US Centers for Disease Control and Prevention (CDC) and the Alliance for Health Policy as more cost-effective, results-driven solutions to pain management than opioids.
In a report on opioid prescription guidelines released in March 2016, the CDC recognizes that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care and end-of-life care, as well as certain acute care situations, if properly dosed. But for other pain management, the CDC recommends non-opioid approaches including physical therapy.
Physical therapists work both independently and as members of multidisciplinary health care teams to enhance the health, well-being, and quality of life of their patients, who present with a wide range of conditions including those that commonly cause pain. The CDC’s recommendations point to “high-quality evidence” that treatments provided by physical therapists are especially effective at reducing pain and improving function in cases of low back pain, fibromyalgia, and hip and knee osteoarthritis. Additionally, a number of studies show the efficacy of physical therapist interventions in preventing, minimizing, and, in some cases, eliminating pain in patients post-surgery, in patients with cancer, and in other clinical scenarios.
Patients who should opt for physical therapy instead of opiates include:
- Those for whom the risks of opioid use are far greater than the potential rewards. With the side effects of opiates ranging from mild cognitive impairment all the way through to depression, addiction, dependence, and overdose, the decision to take these powerful pills should not be made lightly.
- Those who want their treatment to go beyond simply “masking the pain.” Opiates are unrivaled in their ability to knock out even the most intense pain signals to the brain, making them excellent first-line treatments for acute accidents or patients with severe, incurable pain/illness, but for patients who are seeking to truly “get better” and work through their condition, opiates offer no objective benefit. Physical therapists, on the other hand, are trained to help patients increase strength, flexibility, and improve mobility all through the power of guided movement.
- Patients diagnosed with low back pain, hip or knee osteoarthritis, or fibromyalgia. The CDC points to powerful evidence in favor of exercise and physical therapy as the best treatment for these chronic conditions.
- Patients with pain that lasts longer than 90 days. This threshold represents the crossover into “chronic pain” territory, a classification that comes with an increased risk of long-term opiate use and dependence.
Integrated care models, in which primary care doctors work alongside specialists in pain management, physical therapy, and behavioral health, are revolutionizing health care in the United States. These models foster the kind of collaboration that is needed to treat complex problems like chronic pain. They are among our best hopes for an alternative to the overuse of prescription painkillers.
Remember that this information is not intended to replace the advice of your doctor, but rather to increase awareness and help equip patients with information and facilitate conversations with your physician that will benefit your health.
To schedule an appointment with Dr. Dare, call (601) 376-2818.
American Physical Therapy Association
Centers for Disease Control and Prevention