The U.S. Opioid Crisis: How Can Physical Therapy Help?
The CDC’s National Center for Health Statistics released the following information on 11/17/21:
There was an estimated 100,306 drug overdose deaths in the United States during 12-month period ending in April 2021, an increase of 28.5% from the previous year. The overdose deaths caused from opioids increased to 75,673, up from 56,064 the year before.¹
Although these numbers are extremely alarming, it is unfortunately not surprising. Sales of prescription opioids have quadrupled since 1991, even though studies have shown that reports of chronic and acute pain have remained steady.2 In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness.2 Yes, opioids are necessary for pain management in certain illnesses such as cancer or for short-term pain (e.g., post-surgical). However, they are not the best way to treat long-term pain, such as orthopedic pain (e.g., arthritis, low back pain).
So, what is currently being done to address this epidemic in our country? To start, President Trump declared a national state of emergency back in October of 2018. This allowed the Department of Health and Human Services to reduce obstacles to federal funding and allow the development of programs to help combat this disease.3 Congress also passed the SUPPORT for Patients and Communities Act. This legislation changed Medicare reimbursements, treatment bed allocations, prescription restrictions for medication-assisted therapy, and expanded the availability of naloxone to first responders and pharmacies nationwide.3
The CDC website has also outlined Evidence-Based Strategies for Preventing Opioid Overdose:
What do you notice about this chart? Every prevention strategy on this list is based on after a person becomes addicted to opioids. Naloxone distribution and medication-assisted treatment (usually with other opioids such as methadone and buprenorphine) are the top two methods for reducing opioid related deaths. These strategies are essentially fighting fire with fire. Don’t get me wrong, they are absolutely necessary for helping those struggling with active addiction to recover. Without the support of medication, the relapse rate is as high as 90 percent among people with opioid use disorder.5
But what about strategies to address a person’s pain before opioids are even considered? The CDC website goes on to say that "To reverse this epidemic, we need to improve the way we treat pain. We must prevent abuse, addiction, and overdose before they start."1 However, nowhere on the CDC website can actual strategies be found for improving the “way we treat pain.”
Yet, there are endless amounts of evidence-based research detailing how physical therapy intervention is a safe and extremely effective way to treat acute and chronic pain. There are so many research articles in fact, that it is really not even worth citing a select few for this blog. The evidence for physical therapy in managing pain and preventing chronic pain is out there and extremely easy to find on your own. Meanwhile, research on the effectiveness of opioids for long-term pain management show that they often result in unwanted complications. In one study on chronic opioid use post-surgery, it was found that “opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care.”6 Moreover, in a study on PT as the first point of care to treat low back pain, patients who received care from a physical therapist first experienced lower out-of-pocket, pharmacy, and outpatient costs after one year and reduced their likelihood of receiving an opioid prescription by 87% compared with patients who never visited a physical therapist.7
So, how do we get the public to recognize this fact?
Mainly, we need to raise public awareness that physical therapy treatment should be the first option when dealing with orthopedic pain. I know that most of the people reading this blog already has a good understanding of what physical therapy actually is. However, the majority of the population is unaware of how a physical therapist can actually help them. Physical therapists are experts in human movement who use evidence-based medical research to assess and treat all individuals of varying backgrounds and abilities. PT’s help to maximize a person’s movement abilities in order to help them improve their function and quality of life. Based on the PT diagnoses and prognoses, as well as the individuals’ personal goals, PT’s design personalized plans of care, provide appropriate interventions, continually monitor results, and modify treatment as necessary to enhance patient outcomes. There needs to be greater public awareness that the majority of the U.S has some form direct access to physical therapy. This means that a patient can directly seek the services of a physical therapist without having to get a referral from your PCP. This can help save money by cutting out healthcare provider visits, unnecessary tests, and referrals to other specialists.
So, how do we improve public awareness? It can seem like an extremely daunting task. If you know someone dealing with chronic pain, make sure they know their options before considering medications. Also, just because a doctor prescribes you opioid medication, it does not mean you need to take it! If you do happen to go to another healthcare provider first, make sure to ask them about conservative treatment options. Parents, start the conversation about the effects of drugs and the importance of regular exercise with children at a young age. You are a role model for your children, and your views on drugs can strongly affect how they think about them. The most important thing we can do is to educate each other.
Do you feel like pain is limiting you from getting regular exercise? Conservative treatments such as physical therapy can safely and effectively help you to return to the activities you love pain-free, or even start that exercise routine that you have been putting off forever. I cannot say this enough… MOVEMENT IS MEDICINE! If you feel as though pain is limiting you from even starting, please see a physical therapist.
Chances are we all know someone who has been affected by the opioid crisis in our country. The holiday season can be tough for so many people. If you know someone with active addiction and do not know where to turn, a great resource is Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline. 1-800-662-HELP (4357) or 1-800-487-4889 (TDD — for hearing impaired).
References:
1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov.
2. Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019. MMWR Morb Mortal Wkly Rep 2021;70:202–207. DOI: http://dx.doi.org/10.15585/mmwr.mm7006a4external iconexternal icon.
3. Sievers, K., 2021. 10 Things You Need to Know About the Opioid Epidemic. [online] Shatterproof.org. Available at: <https://www.shatterproof.org/blog/10-things-you-need-know-about-opioid-epidemic?gclid=CjwKCAiAhreNBhAYEiwAFGGKPGCF_mi7MucxNOqWKLPJJ0ZBorQ76G_QLSWrIkiXSoW1hJqcR7mcsRoCJr0QAvD_BwE> [Accessed 6 December 2021].
4. Cdc.gov. 2021. Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States | Drug Overdose | CDC Injury Center. [online] Available at: <https://www.cdc.gov/drugoverdose/featured-topics/evidence-based-strategies.html> [Accessed 6 December 2021].
5. Healthcare.utah.edu. 2021. Fighting Fire with Fire: Taking on Opioid Addiction. [online] Available at: <https://healthcare.utah.edu/healthfeed/postings/2019/08/methadone.php> [Accessed 6 December 2021].
6. Hah, Jennifer M.; Bateman, Brian T.; Ratliff, John; et al. “Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic.” Anesthesia and Analgesia, November 2017. https://www.ncbi.nlm.nih.gov/pubmed/29049117 .
7. Frogner, Bianca K.; Harwood, Kenneth; Andrilla, C. Holly A.; et al. “Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs.” Health Services Research, December 2018. https://pubmed.ncbi.nlm.nih.gov/29790166/
Dr. Samantha Benavides
Co-Owner
PT, DPT
