Physical therapy could lower need for opioids

Physical therapists Steven Hunter and Laura Hayes teach an unidentified patient lumbar stabilization exercises at the Equal Access Clinic in Gainesville, Florida. Maria Belen Farias, UF Health Photography, CC BY-SAMark Bishop, University of Florida

Physical therapists help people walk again after a stroke and recover after injury or surgery, but did you know they also prevent exposure to opioids? This is timely, given we are in a public health emergency related to an opioid crisis.

Many people addicted to opioids are first exposed through a medical prescription for pain. Opiate-based drugs provide relief for acute conditions, such as post-surgical pain.

Unfortunately, the effectiveness of opioids decreases after time, requiring higher doses of the drug for the same effects and, perhaps counter-intuitively, worsening pain in some people. Many people progress from this prescription to other opiate derivatives, including heroin and fentanyl. As a result, a growing emphasis has been placed on nonpharmacological alternatives to opioids.

I am a physical therapist and I have studied non-pharmacological methods of preventing the transition from acute to chronic pain. It’s an exciting time for the field, because practice and research are showing that physical therapy could diminish the need for opioids, and thus lower the risk of addiction.

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Reducing initial exposures to opioids

Part of the proposed solution to the opioid crisis is to limit new opioid exposures. Physical therapists are an important part of this process. And it is not just physical therapists who are saying this.

Mindy Miller/University of Florida Photography, CC BY-SA

A letter to the president from the Commission on Combating Drug Addiction and the Opioid Crisis stated, “individuals with acute or chronic pain must have access to non-opioid pain management options. Everything from physical therapy, to non-opioid medications, should be easily accessible as an alternative to opioids.” U.S. Surgeon General Jerome Adams echoed this call for alternative treatments, including physical therapists.

The Centers for Disease Control and Prevention also issued prescribing guidelines in 2016 that recommend physical therapists be considered a first-line treatment for people with chronic pain conditions.

Research supports these positions, including research papers studying opioid use for common musculoskeletal pain conditions like back, knee and neck pain.

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These studies show quite convincingly that the probability of receiving a prescription for opioids is 89 percent lower for people seeing a physical therapist for pain. Seeing the physical therapist sooner, rather than later, makes this protective effect even greater.