According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States. even though “there has not been an overall change in the amount of pain that Americans report.”
In March 2016, the CDC released opioid prescription guidelines in response to a growing opioid epidemic. The guidelines recognize that prescription opioids are appropriate in certain cases such as cancer treatment and end-of-life care, and also in certain acute care situations if dosed properly.
But for other pain management, the CDC recommends non-opioid approaches including physical therapy.
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. The CDC guidelines state that because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” . 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 pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while working 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” that supports exercise as part of a physical therapy treatment plan for those familiar conditions.
- … Your clinician prescribes opioids for pain.
The CDC recommends that patients should receive “the lowest effective dosage,”. Clinicians should prescribe opioids along with nonopioid therapies, such as physical therapy.
- … Pain lasts 90 days.
Clinicians now consider the pain “chronic,” and the risks for continued opioid use are increased. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are “preferred” for chronic pain and that opioid therapy should be an option 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 nonopioid treatment.
The CDC states “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,”
Physical therapists play a valuable role in patient education, including setting realistic expectations for recovery with or without opioids.