The presence of pain is one of the most common reasons people seek health care. National surveys have found that chronic pain – pain lasting longer than 3 months-affects approximately 100 million American adults at a cost of $600 billion annually.
Pain has been described in the medical literature as a “uniquely individual and subjective experience” and “among the most controversial and complex” medical conditions to manage.
The treatment of pain, particularly chronic pain, often requires an integrated, multidisciplinary approach due to the many variables that may contribute to a patient’s perception of pain and response to treatment.
The problem is that many people, even those in health professions, look to simple, one-stop solutions to pain and many times that involves the use of opioids.
When the CDC issued its guideline for prescribing opioids in 2016, it was against the backdrop of a national crisis. In 2016 alone, more than 42,000 people in the United States died from an opioid overdose, including more than 17,000 whose deaths were attributed to prescription opioid overdoses. Deaths caused by overdose of prescription opioids have quadrupled over the past 15 years.
In its “Guideline for Prescribing Opioids for Chronic Pain,” the U.S. Centers for Disease Control and Prevention (CDC) said that “Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain,” adding “many non-pharmacologic therapies, including physical therapy…can ameliorate chronic pain.”
In a white paper “Moving Away From Opioid Reliance,” on the American Physical Therapy Association’s website (apta.org) it outlines the many ways the APTA and other organizations are leading the drive to expand physical therapy’s role in pain management.
“Physical therapy is a dynamic profession with an established theoretical and scientific basis for therapeutic interventions capable of restoring, maintaining, and promoting optimal physical function,” writes white paper author Chris Hayhurst. “Physical therapists work both independently and as members of multidisciplinary health care teams to enhance the health, well-being, and quality of life of their patients, who present with a wide range of conditions including those that commonly cause pain.”
Hayhurst writes that the CDC’s recommendations point to “high-quality evidence” that treatments provided by PTs are especially effective at reducing pain and improving function in cases of low back pain, fibromyalgia, and hip and knee osteoarthritis. Additionally, a number of studies show the efficacy of physical therapist interventions in preventing, minimizing, and, in some cases, eliminating pain in patients postsurgery, in patients with cancer, and in other clinical scenarios.
“Across the profession,” says Alice Bell, PT, DPT, senior payment specialist at APTA, “we’re seeing more and more patients who are accessing physical therapy before opioids are prescribed, or who’ve been on opioids but realize they aren’t helping to treat or manage their underlying conditions.”
Hayhurst concludes that “Ending the opioid epidemic will require collaboration among patients, families, providers, payers, and professionals across the continuum of health care settings, from primary care practices and pharmacies to hospitals and behavioral health facilities. Physical therapists, who engage in an examination process that focuses on not only the symptoms of pain but also the movement patterns that may be contributing to pain, must become central to this multidisciplinary strategy.”