Opiods vs. Physical Therapy
By Kristin Anderson, PT, DPT, OCS, CLT
The opioid epidemic came to a head in March of 2016 when the CDC released opioid prescription guidelines. These guidelines were established after the sales of prescription opioids quadrupled without increased reports of pain by Americans (APTA, Move Forward). The guidelines recognize that opioids are appropriate in certain situations including: “cancer treatments, palliative care, end of life care and certain acute care situations” (CDC). However, many patients who suffer from persistent pain were started on opioids in the past and continue to struggle with pain control.
So where do we go from here? According to current research, the CDC recommends non-opioid therapies, such as physical therapy, to replace or be used in conjunction with opioids for acute and persistent pain. Physical therapy has been shown with “high quality evidence” (CDC) to help reduce pain. Here are a few ways that physical therapy can help:
Physical therapy doesn’t just “mask” the pain: While we know at times opioids are warranted, to enable people to function throughout the day, we also know that opioids not a “cure.” When looking for reasons for acute and chronic pain, it is important to understand WHY you have your pain. Physical therapy will empower you by helping you to understand and fix the underlying causes of your pain. This is an imperative step in managing your pain, not just masking it.
Exercise is a proven pain reliever: Opioids work by mimicking natural endorphins in the brain and body. Beta-endorphins are the natural occurring endorphins that when bound to opioid receptors in the brain and body have a strong pain-relieving effect (Bender, et al). Exercise is a proven way to increase our natural endorphins and reduce pain! It is an important aspect of pain modulation and should be utilized with patients who are in pain, to the best of their ability. A physical therapist can help guide you in the type and duration of exercise that is appropriate and meaningful for you. Physical therapists are the ideal providers to help you get started on your exercise journey.
Physical therapy has less side effects! Opioids have risk factors of “depression, overdose, addiction and withdrawal” (APTA, Move Forward). Physical therapy is a way to help with pain control without the side effects!
Opioids continue to have their place in pain control, however due to new evidence as well as new guidelines, it remains important that we use non-opioid treatments or use them in conjunction with opioids to help manage and get to the root cause of your pain. If you are in acute or chronic pain remember, to discuss options with your physician and make sure physical therapy is a part of your treatment plan!
APTA. Move Forward: Physical Therapy vs Opoids When To Choose Therapy for Pain Management. https://www.moveforwardpt.com/resources/detail/physical-therapy-vs-opioids-when-to-choose-physical. (2018).
Bender, T, Nagy, G, et al. “The effect of physical therapy on beta-endorphin levels.” European Journal of Applied Physiology; Vol 100, 4:371-382, (2007).
CDC (Center for Disease Control) Guideline for Prescribing Opioids for Chronic Pain. https://www.cdc.gov/drugoverdose/prescribing/guideline.html (2017).