PHYSICAL THERAPY INSTEAD OF OPIOID DRUGS
Tid Bits of Info
- It is estimated that over 100 million people suffer from chronic pain.
- The American Physical Therapy Association has begun a social media campaign entitled, # ChoosePT to combat abuse of opioid drugs.
- Nearly ½ of all opioid deaths are a result of an overdose of prescription painkilling drugs.
- More than 2million people are treated yearly for addiction to prescription painkilling drugs.
- If you suffer from chronic pain, seek the advice and treatment from a Physical Therapist.
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.
I am really glad that PT is being highlighted as an alternative to opioids. Not only are they addictive, but they can cause dangerous transient cognitive changes and long-term damage to multiple systems. However, I think PT has a long way to go and a lot of educating to do before the public really takes to “PT First”. The stigma that PT stands for “pain and torture” still exists. In addition to that, I don’t think when people are in pain their first thought is, “I should stretch and exercise!”. So that’s really where we need to advocate for ourselves and let people know that sometimes, exercise is exactly what you need to relieve pain and in the situations where joint and soft tissue mobilization is the key, PT’s can do that too.
More and more people are learning about the numerous side effects of pain medications and are seeking other pain reduction methods thanks to articles like this. Physical therapy offers different pain reduction techniques and exercises that could effectively reduce pain. Most of the pain medications metabolize in liver. Poly-pharmacy is also another issue in elderly people who take multiple medications for their health problems. Since most of the medications metabolize through the liver, the addition of just one more medication, such as painkillers, could cause irreversible liver and/or renal problems for these patients. Not only physical therapy techniques, therapeutic exercises and modalities could be used effectively to reduce pain, they could help prevent the irreversible effects of painkillers that could possibly put a patient in more danger and difficulty.
Very timely article and great introduction to visceral and somatic pain and benefits of movement. This article further confirms why a bike, elliptical or treadmill warm up can be an important part of physical therapy in managing pain prior to treatment to stimulate our body’s natural opiates. The additional falls risk associated with opiate prescription is very concerning for the physical therapist. When determining and managing therapy for a person recovering from a musculoskeletal injury taking opiates the therapist must be diligent in their supervision of the patient. Carryover can be poor and patients can be more susceptible to violation of their protocols. Relying on a skilled physical therapist to appropriately dose and guide movement without the concerns of opiate side effects can be beneficial in recovery.
Opioid use is a common step in an individuals process with dealing with pain but it doesn’t have to be the only step. Opioid use is on the rise and it can lead to many things such as addiction, overdose, orthostatic hypotension, and gastrointestinal discomfort. All of which can be avoided if an individual seeks PT for pain relief. As the above article states opioid use is a temporary relief to the pain and isn’t permanent if an individual wants permanent paint they need to learn how to process the pain in a normal process not block it or dull it with medication. PT can help show individuals different approaches to relieve pain such as ice, TENS, heat, and most importantly movement! If you are having pain it is important to not suffer through it but it is also just as important to understand you have other options to help you through this process.