With overuse of opioids for the treatment of chronic pain becoming a national public health epidemic, the Centers for Disease Control and Prevention (CDC) released guidelines that recommend nondrug approaches such as physical therapy over long-term or high-dosage use of addictive prescription painkillers.
"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain," the guidelines state ("CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016" - March 15, 2016). "Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate."
While there are certain conditions - including cancer treatment, palliative care, and end-of-life care - where opioid prescription for chronic pain may be appropriate, the CDC cited numerous cases where opioid use could be significantly reduced or avoided altogether.
"The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT (cognitive behavioral therapy), and certain interventional procedures can ameliorate chronic pain," the guidelines state. "There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2-6 months. Previous guidelines have strongly recommended aerobic, aquatic, and/or resistance exercises for patients with osteoarthritis of the knee or hip. Exercise therapy also can help reduce pain and improve function in low back pain and can improve global well-being and physical function in fibromyalgia."
Physical therapists partner with patients, their families, and other health care professionals to manage pain, often reducing or eliminating the need for opioids. Research has shown that a simple education session with a physical therapist can lead to improved function, range of motion, and decreased pain.
Before you agree to a prescription for opioids, ask if physical therapy might be right for you.
Kenneth Mauck, MPT, MS , Manual Therapy Expert