Doctors sometimes prescribe opioid drugs to help manage moderate to severe pain. While they can bring relief, they can cause dependence when taken for an extended period. Because of the potential for addiction and other side effects, many healthcare professionals are recommending other protocols for managing chronic pain. Physical Therapy offers a helpful alternative to narcotics for managing pain and continuing to enjoy an active life.
Patients with nociceptive pain find more success with alternate treatments. This kind of pain arises from the musculoskeletal system and can be further described as visceral or somatic. Visceral pain arises from the organs of the body. Somatic pain is from the musculoskeletal system skin, bones, muscle, connective tissue, and joints, and it is often associated with inflammation, which can be the primary stimulus of the nerve that transmits the “pain” signal to the brain.
This kind of pain is the most common type that is encountered in the orthopaedic world and many orthopaedic doctors are promoting protocols that are far less dependent on opioid or narcotic pain medication. The American Academy of Orthopaedic Surgeons (AAOS) has joined in the promotion of utilizing other ways to control pain associated with orthopaedic conditions. In the past, many chronic conditions such as low back pain have been controlled the symptoms with the use of opioid drugs. The patients using these drugs often times become dependent upon them to function. There are many health and social issues that arise when someone is on these narcotic drugs for a prolonged time period and in the worst-case scenario, they can lead to death.
Many Physical Therapy protocols revolve around movement and activity and this makes it particularly popular. When someone moves rhythmically and consistently for several minutes, there is a release of endogenous chemicals (opiates) or natural painkillers that help to reduce pain. These endogenous opiates are commonly referred to as endorphins. If the patient continues to move there is a constant release of these endogenous opiates. Some studies have shown that low-level exercise (i.e. walking) can promote the release of endocannabinoids which help to produce a feeling of “well-being”. The studies indicate that everyone can benefit from this type of treatment and it only has to be performed for a short period of time. Studies have shown that a short, 10 minute, bout of intense exercise can produce a stimulus to release the endogenous opiates.
Physical Therapists use a range of modalities to treat pain such as hot packs, ice, and electrical stimulation. Many Physical Therapists will utilize their manual techniques to reduce the symptom of pain. Movement of the involved area can help to stimulate the blood flow to the area. This helps to reduce the metabolic by-products that are produced when the body is healing, and they are an irritant that causes the pain. The increase in blood flow and movement helps to increase the tissue and joint temperature, which reduces the viscosity of the fluids in the involved area. Gentle exercise or “active rest” is always a good way to help reduce pain for the same reason.
Opioid drugs have a place in the treatment of pain, but they are not a long-term pain solution to pain that is nociceptive in origin. Short term use of narcotic drugs to reduce acute pain following surgery or acute trauma is acceptable. The goal is to have the patient reduce and eliminate their use of these drugs as soon as possible and utilize non-habit forming drugs and other techniques to control their pain.