Physical Therapy as a First Line Treatment of Opioid Addiction and Chronic Pain

Physical Therapy as a First Line Treatment of Opioid Addiction and Chronic Pain
It is estimated that 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin [1]. That number is on the rise. Where do people get the drugs? For 1 in 5 people it is prescription medications which are prescribed by a medical provider for valid reasons. For over 54% of people, the drugs are given to them by friends or relatives. This means they were not prescribed these medications and are highly likely to lack education about what these drugs will do to their system. Prescription opiates are powerful drugs that can help alleviate the brain’s perception of pain. But they are also the same drugs that come from the same plants that used to create heroine, perhaps the most addictive substance on the planet.
The Centers for Disease Control and Prevention (CDC) issued new guidelines in March 2016 for the prescription of opioids. It states they are appropriate for certain cases such as cancer treatment, palliative and end-of-life care, and in acute care situations if properly dosed. The CDC recommendation also includes the use of non-opioid interventions including Physical Therapy.
Every day our Physical Therapy clinic works with people who are on strong pain medications after an injury, accident, or surgery. In the short term, this is fine, but we sometimes see people who have become dependent on and even addicted to those meds. This can happen for several possible reasons. Sometimes it’s associated with the depression that comes after an injury, especially an auto or work injury. Sometimes it’s because of a probable genetic predisposition. Other times it is because their medical provider may have prescribed too much medication. Whatever the case may be, whenever there is a significant episode of pain and opioids are prescribed there is a chance for possible dependency.
Prescription medication addiction has finally started to get some considerable attention. In March 2016 and May 2016 the New York Times ran editorial pieces about the negative impact of prescription medication on society. Recognizing that the opioid epidemic is a leading cause of death in the United States, Congress and local governments are starting to take action. Massachusetts has passed a new law regulating the duration someone can be prescribed an opiate. This may help prevent some people from dependency but does not offer an alternative for those you do become dependent. One possible course of action is the use of non-pharmacological Physical Therapy treatments designed to desensitize the nervous system, literally modifying the neural tissues of the brain and peripheral nervous system. Desensitization techniques are an important first step toward reducing pain and dependency on prescription meds, but we often also find specific joint or muscle lesions which when treated provide additional relief and can restore normal function. The next phase of Physical Therapy would be to gradually and carefully reintegrate normal movement patterns once the pain levels have reduced. Based on the experience in our practice, about 1 in 3 chronic pain patients are able to achieve full resolution of their symptoms. Another 1 in 3 have a significant reduction of symptoms and improvement in function. This is consistent with the CDC recommendation to consider the use of Physical Therapy to manage chronic pain and reduce or eliminate opioid dependence.