A New Fight for Physical Therapy: The US Opioid Crisis By James Boland, SPT

It’s December 20th, and if you’re anything like me, this marks the perfect time to start Christmas shopping. So for the entirety of the day you traverse the whole town from Target to Walmart and to every shop in between until you’re finally unloading the trunk of your car and….”POP!” Now most of your holiday gifts are lying on the floor and you’re clutching your back in excruciating pain while stringing along eloquent phrases of expletive language and choice words like Charlie Parker improvising a jazz solo. You struggle to bring all of your new bought goods inside before finally reaching the medicine cabinet at home so you can swallow a couple Advil to ease the pain. You’re a little sore, but for the most part you’re feeling fine for the next few hours, until you wake up the next morning in arguably more pain than you were in the first place! So you do what seems to help, you take a few more Advil, and the pain-pill-pain cycle repeats.

Why do we use medications after an injury?

The sensation of pain is distressing and when something hurts we do as much as we can to avoid eliciting pain, which consequently means we limit our movement and begin to fear moving. When we take painkillers we give ourselves a brief respite from agony, which allows us to move and function more comfortably than before. However, there are many misconceptions about pain killing drugs, the chief falsehood being that painkillers like opioids play a role in healing, which is not the case! They are simply temporarily blocking the pain signals in our bodies.

Opioids and the Case for Physical Therapy

Between 1999 and 2017, the CDC cites over 200,000 deaths related to very potent and highly addictive prescription opioids, not including deaths related to heroin or illegally attained opiates. Nearly a quarter million preventable deaths could have been avoided if opioids weren’t prescribed. Opioids are prescribed for a number of reasons but in the event of a musculoskeletal injury, a patient does not need a pill, they need to heal! They need exercise.

In the United States, Doctors of Physical Therapists are autonomous practitioners and experts in human movement, pain management, and rehabilitation. Patients have direct access to physical therapy services in the U.S., meaning that anyone can independently schedule a physical therapy evaluation or appointment, without needing a physician referral or dealing with the red tape and hassle of being dragged around the healthcare system.

When presented with an injury, you, the patient, are your own greatest advocate. You should be able to feel confident in the decisions you make regarding your own health, and shouldn’t feel pressured into elective surgeries and opioid prescriptions. Instead you should exhaust all conservative methods or treatment like physical therapy before considering invasive operations and pharmaceutical intervention, which have been linked to opioid prescription and subsequent abuse.

Over the counter painkillers and anti-inflammatories (eg. Advil, Tylenol, Aleve) are more than enough when it comes to easing discomfort and have a place in medical interventions, but as an adjunct to proven methods like physical therapy, not as a main treatment! They’re useful at dulling pain and allow an injured person to move more confidently and begin rehabilitation and exercise, which is the true catalyst of healing, strengthening and preventing future injuries.

Why did I hurt myself?

Musculoskeletal injuries are diverse and can occur in a variety of ways, but the basic principle behind the cause of the injury is simple: When a load or demand that is too great is placed on your body (i.e. your bones, muscles, tendons, ligaments, and connective tissues of joints), the result is injury. While painkillers help ease the resulting pain, it’s a temporary solution at best, akin to slapping a Band Aid on a leaky ceiling. Sure less water is dripping, but the ceiling is still damaged! You are in less pain, but you still have a musculoskeletal injury!

How can I HEAL after an injury?

Academic literature time and time again shows the benefit of exercise and the role it plays in the healing process. Exercise (a cornerstone in Physical Therapy) in the form of strengthening, stretching, aerobic conditioning and more have been shown to naturally inhibit pain, influence the healing process through inflammatory and immune system responses, and most importantly causes physiological changes in our tissues! The last point is a vital and explains how we adapt in response to exercise. When we consistently stretch, the elasticity of our muscles and tendons changes and we become more flexible, and when we strength train, our muscles grow and are able to withstand greater demands.

So after an injury and once pain is manageable, exercise is vital to influence true healing and initiate adaptations that allow us to avoid injury in the future!

Brass Tacks and Hard Facts

The bottom line is this: physical therapy treatment directly combats the opioid crisis and decreases the likelihood of drug abuse in patients. A recent study reviewing 88,985 patient-cases, funded by the National Institute on Drug Abuse, by authors from the Stanford University School of Medicine and the Duke University School of Medicine concluded “Early physical therapy appears to be associated with subsequent reductions in longer-term opioid use and lower-intensity opioid use for all of the musculoskeletal pain regions examined.” ¹ In addition to these recent findings, the Surgeon General of the United States, Jerome Adams M.D., M.P.H, has gone on record when speaking to APTA (American Physical Therapy Association) supporting physical therapy in the fight against opioid abuse, “Physical therapists are key to overcoming not only the opioid epidemic but in creating healthier societies,” Adams said. “Know that you have no bigger fan than the United States surgeon general.” ²

With the backing of scientific literature and the highest ranking public health official on record touting the benefits and importance of physical therapy, one question remains: Why on earth would you risk addiction and choose a pill?

Citations

1. Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open.2018;1(8):e185909. doi:10.1001/jamanetworkopen.2018.5909
2. “‘No Bigger Fan’: US Surgeon General Believes the Physical Therapy Profession Is a Key Player in the Fight Against Opioid Misuse.” APTA, www.apta.org/PTinMotion/News/2019/1/23/SurgeonGeneral/?fbclid=IwAR261fXYnYKXgRa9K5ALiYDJJOK4YAGQM336X0nqgS4610rDTHq-SvT9N98.
3. cdc.gov. (2019). Understanding the Epidemic | Drug Overdose | CDC Injury Center. [online] Available at: https://www.cdc.gov/drugoverdose/epidemic/index.html [Accessed 3 Feb. 2019].

James Boland is a Student Physical Therapist studying at Temple University in Philadelphia to earn his Doctor of Physical Therapy degree (DPT). He believes that the profession of Physical Therapy will positively transform the nature of health care through exercise, education, and personalized plans of care (among others!). He firmly believes that impersonal care by health care providers and the “pharmaceutical culture” of health care today are detriments to a healthy society.