That’s every October. But this October is different.
This year, buoyed by a Centers for Disease Control and Prevention recommendation that Americans look to physical therapy (PT) as an alternative to pain-masking opioids, PT professionals are in position to do their part in fighting an opioid epidemic that kills as many as 140 Americans each day.
The class of medications called opioids — codeine, hydrocodone, oxycodone, methadone and others — works by interrupting the flow of pain signals to the brain, masking the pain. They have a place in treatment of moderate to severe short-term pain, but they do nothing to alter the source of pain. Prolonged use of an opioid can produce a tolerance for the drug, and this in turn can lead to addiction, which can result in overdose and death. According to the American Society of Addiction Medicine, 20,101 Americans died of overdoses related to prescription pain relievers in 2015.
In response, the Centers for Disease control last year released guidelines urging prescribers to reduce the use of opioids in favor of safer alternatives to treat chronic pain. One of those alternatives: physical therapy.
Orthopedic Physical Therapy, Inc. in Richmond, VA is a practice that specializes in treating people who are in chronic pain – pain that lasts for roughly six months or more. Its founder, Tracey Adler, PT, DPT, OCS, CMTPT, notes that only about four percent of the estimated 300,000 physical therapists in the US focus almost exclusively on treating patients with chronic pain. The goals of treatment are to reduce pain and restore function to the musculoskeletal system – joints, tendon, ligaments, and bones – in our bodies.
“Our goal,” Adler says, “is to find and treat the source of pain instead of the symptoms. Painkiller drugs such as opioids can treat the symptoms, but the risk of opioids may many times outweigh the reward.”
This past August, we saw strong evidence of the value of physical therapists in heading off the pain that is so often a gateway to opioid abuse. In a research letter published in the journal JAMA Surgery, the authors of a study found that most patients who use opioid medications for six months or more get their first prescription for some sort of back pain, or to combat pain described in medical code as “other ill-defined conditions.” Translated, this could well mean that potential opioid abusers take the medication not as a result of surgical pain as had been earlier suspected, but as a result of back pain or some other pain where a root cause is unclear.
First Call for Many?
This finding is very much in line with Adler’s contention, echoed by many other physical therapy experts, that a physical therapist should be the first call by people suffering pain in the lower back or other joints, as well as fibromyalgia, a disorder characterized by widespread musculoskeletal pain.
She notes that patients in all states can now go directly to a physical therapist without first seeking a referral from a physician. “We’re well equipped to make an evaluation of the source of the pain and see if it’s within our scope to treat it,” explains Adler. “If we are unable to provide the necessary treatment, we refer the person to the right specialist.”
Interestingly, Adler mentions, in the military, physical therapists are often the medical professionals responsible for triage, which involves sorting out patients according to their medical needs and assigning them to the appropriate sources of treatment.
“Most people don’t have to live their lives in pain,” says Alder. “A properly trained physical therapist can not only evaluate musculoskeletal structures that may be the source of pain, but also treat it.”
Expert Contributior: Tracey Adler, PT, DPT, OCS, CMTPT, founder of Orthopedic Physical Therapy, Inc. in Richmond