By Meggie Morley, DPT Student
In recent years there has been a rise of prescription opioid use in the United States. On the average day, 650,000 opioid prescriptions are dispensed and between the years 2000 and 2010 the amount of opioid prescriptions nearly doubled from 11.3% to 19.6% among all pain visits . There are patient scenarios when opioid prescription and use is appropriate such as hospice, palliative care, and acute pain management, but for the treatment of chronic pain (pain lasting three months or greater) there is not clear evidence suggesting that opioid use is beneficial.
As the rise in opioid use becomes a national epidemic, the CDC has released guidelines for prescribing opioids for chronic pain. The guidelines also recommend chronic pain management with non-drug choices such as physical therapy, cognitive behavioral therapy and weight loss. As opioids have side effects such as sedation, dizziness, nausea, dependence and respiratory depression, treatments such as physical therapy may be a beneficial alternative.
In a systematic review by Hayden et al, sixty-six studies were reviewed to examine the effects of exercise therapy for low back pain versus other conservative treatments or no treatment.
Sixty-one randomized control trials met the inclusion criteria of evaluating the effectiveness of exercise on acute, sub-acute, and chronic low back pain. The outcome measures for patient improvement were both pain and functional scales. The authors concluded that exercise therapy is effective for decreasing pain and improving patient function among adults with chronic low back pain. The results for sub-acute low back pain were inconclusive, and exercise therapy for acute low back pain was determined to have the same effectiveness of other conservative treatments or no treatment.
The management of chronic pain is a complex issue, but education for both healthcare providers and patients on the various treatment options is critical for addressing the rise of opioid use in the United States. More information can be found on the APTA website, where they have started a campaign titled #ChoosePT to further discuss physical therapy as a method for treating chronic pain.
Blog Post written by Meggie Morley, DPT Student at Columbia University. Meggie is currently in her final Clinical Rotation with me at Catz Physical Therapy Institute.
Sources
Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, Kruszewski SP, Alexander GC. Ambulatory diagnosis and treatment of non-malignant pain in the United States, 2000–2010. Medical care. 2013 Oct;51(10).
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opiods for Chronic Pain – United Staes, 2016. MMWR Recomm Rep 2016;65(No. RR-1):49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.
| Hayden J, Van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non‐specific low back pain. The Cochrane Library. 2005 Jul 20. |
http://www.moveforwardpt.com/Resources/Detail/physical-therapy-vs-opioids-when-to-choose-physica
Chris Butler Sports PT 