Physical Therapy vs Opioids: When to Choose PT
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 response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.
But for other pain management, the CDC recommends nonopioid approaches including physical therapy.
Patients should choose physical therapy when …
- … Patients are concerned about the risks of opioid use.
“Given the substantial evidence gaps on opioids, uncertain benefits of long-term use, and potential for serious harms, 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. Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids. As the CDC guidelines note, even in cases when evidence on the long-term benefits of nonopioid therapies is limited, “risks are much lower” with nonopioid treatment plans.
- … Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
The CDC cited “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 nonopioid treatment.
- Health Center on Opioid Use for Pain Management
- CDC Recommends Physical Therapy and Other Nondrug Options for Chronic Pain
- Using Opioids for More Than 30 Days Could Increase Depression Risk
- Widespread Pain is Creating Widespread Prescription Drug Use
- Health Center on Pain
This article was originally published on the American Physical Therapy Association website. Click here to view it.