Transforming Chronic Pain To Avoid Addictive Opioids

One thing you can say about the opioid abuse epidemic: it doesn’t discriminate. The destructive power of the drugs, often first prescribed to treat pain, has been felt from rural to urban areas, across all social and economic classes, and from factory workers to one-of-a-kind music icons. The opioid epidemic continues to devastate lives and communities in the United States.

Although prescription opioids are appropriate in certain cases, such as cancer treatment, palliative care, and end-of-life care – given the risks of long-term opioid use, the CDC and industry experts strongly recommend nonopioid approaches like physical therapy for the management of most chronic pain.

“Despite intensive media coverage over the past 2 years, there are aspects of the opioid epidemic that need significantly more discussion, understanding, and awareness,” says Dr. Tammara Moore, DPT and founder of SOL Physical Therapy + Performance.  “This crisis is not just about fentanyl, overdose, and addiction, it’s also about educating all our patients and clients so they know they have options in pain management and the prevention of chronic disease.”

No one wants to live in pain.  However,  no one should put their health at risk in an effort to be pain free.

Opioids are a classification of drugs that includes hydrocodone (eg, Vicodin), oxycodone (eg, OxyContin and Percocet, which combines oxycodone with acetaminophen), oxymorphone (eg, Opana), and methadone.  Although Doctor-prescribed opioids may be appropriate in some cases, regrettably they just mask the pain—and opioid risks include depression, overdose, and addiction, plus withdrawal symptoms when stopping use. That’s why the experts and the CDC recommend safer alternatives like physical therapy to manage pain.

Physical therapists treat pain through movement, hands-on care, and patient education, thereby resulting in positive side effects like improved mobility, independence, and wellness – and by increasing physical activity you can also reduce your risk of other chronic diseases.

Patients should choose physical therapy when …

… The risks of opioid use outweigh the rewards.

Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.

… 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 nonopioid therapies, such as physical therapy.

… Pain lasts 90 days.

At this point, the pain is considered “chronic,” and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are “preferred” for chronic pain and that “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for non-opioid treatment.

“Given the substantial evidence gaps on opioids, uncertain benefits of long- term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions,” the CDC states.

SOL Physical therapists can play a valuable role in your patient education process, including setting realistic expectations for recovery with or without opioids.  Give us a call today!

Source: American Physical Therapy Association

About the author

Sports + Orthopedic Leaders Physical Therapy & Performance Training serves the communities of Oakland, Alameda, Berkeley, Walnut Creek, Orinda, San Francisco and beyond. SOLPT’s award winning team of Physical Therapists, Performance Coaches and movement experts has helped thousands reach their rehabilitation and performance goals to move beyond pain. We're committed to helping anyone of any fitness level move effectively and more powerfully for a lifetime. We offer rehabilitation and performance services to all populations, with specialties in Sports Rehabilitation, Active Release Techniques, and Manual Therapy Techniques plus Personal and Small Group Training, Sport Clinics and Wellness Services.

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