Pain Medication vs. Physical Therapy
Opioids are a class of drugs used for pain relief and include prescription drugs such as oxycodone, hydrocodone, codeine, morphine and others. It also includes illegal drugs such as heroin and synthetic fentanyl. On average, 130 Americans die every day due to an opioid overdose. In 2017, the number of overdose deaths involving opioids was 6 times higher than in 1999.
One of the best ways to avoid risk of opioid addiction is to avoid exposure to them at all. The CDC has a list of options to relieve pain as opposed to prescription pain medication, one of which is exercise therapy, including Physical Therapy. Other therapies include massage therapy and acupuncture. Cognitive behavioral therapy is a psychological based therapy to teach patients how to modify their triggers to pain and stress. While pain medication aims to mask the pain, these therapies aim to treat the sources of the pain (both physical and mental/emotional). Chronic pain, defined as pain lasting longer than 3 months, is complex. Not only is there physical pain, but there is often stress, depression, anxiety, fear and sleep disturbances. Over time, there is a change to the central nervous system
Physical therapy reduces pain, improves movement and function, thereby improving quality of life. The main treatments used in physical therapy to achieve these goals:
1. Exercise - A sedentary lifestyle is associated with pain. Physical therapists are movement specialists and will first assess your current pain and ability to move, then develop and teach you exercises appropriate for your current level. As you improve, these exercises will be modified and progressed.
2. Manual therapy - This is hands on treatment for your soft tissues and joints. These techniques can reduce pain, reduce swelling, and improve mobility of muscles and joints.
3. Education - Understanding the complexity of pain, especially chronic pain helps patients self manage their pain. There are interventions that help people with chronic pain have a better quality of life, but they seem counter-intuitive unless you understand the science of chronic pain. For example, people with chronic pain don’t think they should exercise. But movement has a very important role in managing chronic pain. Fear, anxiety and depression often contribute to the patient’s pain. Physical therapists also educate patients on these aspects of pain and teach mindfulness, relaxation techniques, supportive resting positions and activity pacing to help the patient feel back in control.
The opioid epidemic is spurring research aimed at finding effective alternatives to opioids. A study by Frogner and colleagues showed that seeing a physical therapist first for an episode of low back pain lowered the probability of getting an opioid prescription.
1. Opioids Portal, Centers for Disease Control and Prevention website https://www.cdc.gov/drugoverdose/epidemic/index.html
2. Frogner B, Harwood K, Ardrilla H, Schwartz M, Pines. Physical therapy as the first point of care to treat low back pain: an instrumental variables approach to estimate impact on opioid prescription, health care utilization and costs. Health Serv Res May 23, 2018.
3. Hayhurst C. Moving away from opioid reliance. PTinMOTIONmag.org Oct, 2018. p33-44