An Alternative to Opioids – Physical Therapy as Means to Treat Chronic Pain

By Kindred Hospital Rehabilitation Services tags: Chronic Pain, physical therapy

The American Physical Therapy Association (APTA) chose October – which is National Physical Therapy Month – to remind caregivers and the general public that physical therapy remains a safe and effective alternative to opioids for the treatment of chronic pain.

Because Americans continue to misuse prescribed opioids at alarming rates, the APTA launched its #Choose PT campaign in October to build public awareness and equip clinicians with evidence-based resources on the treatment of pain and chronic conditions.

The APTA campaign includes insights about the opioid epidemic as well as information on how physical therapy can be used to effectively manage chronic pain conditions.

Some Things You Should Know About the Opioid Epidemic

The APTA materials provide context regarding opioid use today and highlights the CDC’s recommendation of taking non-opioid approaches for treating chronic pain – approaches like physical therapy. Here are four things the APTA wants everyone to know:

  1. The opioid epidemic doesn’t discriminate.

    Virtually every age, gender, race, socio-economic group, and community in the nation has been impacted by the opioid crisis. According to the CDC, nearly 50 people die every day from overdoses involving prescription opioids. In 2017, the US Department of Health and Human Services declared the opioid epidemic a public health emergency.

  2. The CDC recommends non-opioid approaches for chronic pain.

    In March 2016, the CDC released guidelines urging clinicians to consider opioid therapy “only if expected benefits for both pain and function are anticipated to outweigh the risks to the patient.” Before prescribing opioids, providers are encouraged to check that non-opioid therapies have been tried and optimized. In cases when opioids are prescribed, providers are encouraged to “start low and go slow” with dosing and to combine with non-drug approaches like physical therapy. Cancer treatment, palliative care, end-of-life care and certain acute care situations are cited as cases in which properly dosed opioid therapy may be appropriate.

  3. APTA’s #ChoosePT campaign provides resources for patients and clients.

    APTA’s national campaign raises awareness about the risks of opioids and the safety and effectiveness of physical therapy for pain management. Resources include a downloadable pain assessment that patients can use to facilitate treatment conversations with their health care providers. Clinicians are advised to direct patients and clients and prescribers to www.MoveForwardPT.com/ChoosePT. They can explore the site and access the online tool kit to help educate patients and the community.

  4. APTA’s PTNow website includes resources for clinicians. Clinicians can access evidence-based resources on the treatment of pain and chronic conditions by visiting www.PTNow.org/Opioid.

The Role of PTs in the Treatment of Pain and Prevention of Chronic Pain

So, what exactly can physical therapy do to address chronic pain? Because chronic pain can be considered a disease state and can persist for months or years, a PTs treatment is typically a multi-layered plan to address cause and symptoms. When PTs begin their work with patients in pain, they use tests and measures to determine the causes of that pain and to assess its intensity, quality, and temporal and physical characteristics.

Once the contributors to a patient’s pain are identified, the PT designs an individualized treatment program combining the most appropriate techniques, including but not limited to exercise, manual therapy and patient education to address the underlying problem. From the perspective of Kindred Rehabilitation Services, the plan might include the following:

  • Exercise. Studies have shown that people who exercise regularly experience less pain. PTs develop, administer, modify and progress exercise prescriptions and programs to address poor conditioning, impaired strength, musculoskeletal imbalances, or deficiencies that may lead to pain.
  • Manual therapy. Manual therapy involves hands-on manipulation of joints and soft tissue to modulate pain, reduce swelling and inflammation, and improve mobility. Research shows that manual therapy techniques are effective at reducing low back pain, discomfort associated with carpal tunnel syndrome and other sources of pain.
  • Stress management. Interventions such as mindfulness, relaxation, visualization and graded exposure to stress-producing events can help patients reduce pain and improve their functional capacities.
  • Sleep hygiene. Individuals with persistent pain often complain of sleep disturbances. Evidence has shown that sleep deprivation can increase sensitivity levels and contribute to increased stress and pain. PTs can help educate patients regarding appropriate sleep hygiene to help combat the vicious cycle of persistent pain.
  • Pain neuroscience education. Individuals who don’t understand the mechanisms and contributors to their pain may be more likely to seek pharmacological treatment for that pain. PTs can educate patients about modern pain science that highlights the processes involved in pain. The adage “know pain, know gain” can empower patients and provide hope and encouragement in their journey to overcome persistent pain.

To learn more about the APTA’s #ChoosePT campaign, visit www.MoveForwardPT.com/ChoosePT. To discover more about how Kindred Rehabilitation Services helps patients with chronic pain and other conditions on their road to recovery, visit www.kindredrehab.com.