January 30, 2017
Can physical therapy alleviate nationwide opioid dependence? The truth about safer pain management
A quick glance at national headlines in a given week will undoubtedly yield harrowing information regarding the opioid crisis in America. “Opioid epidemic declared public health emergency,” one might say, with another declaring “White House leadership is key to ending the opioid crisis!”
With this topic being painstakingly explored from a number of different angles, many are beginning to ask what can be done to curb this unsettling American epidemic. This effort inevitably brings us to what many would consider the root of the issue: a flawed approach to pain management.
“At the heart of this controversy is the desire to relieve the greatest of evils — physical pain — without replacing it with the evil of addiction,” writes Dr. Amy Baxter, founder and CEO of MMJ Labs Pain Relief. “Solving the problem of pain requires shifts in the understanding of pain, the language of relief and the regulatory landscape and lack of other options that promote prescriptions.”
Join us as we explore the facts surrounding the opioid crisis, the new recommendations from the Centers for Disease Control and Prevention (CDC), the benefits of non-pharmacological treatment and safer pain management options to consider.
America’s opioid epidemic: The frightening facts
According to the American Society of Addiction Medicine (ASAM), opioids are a class of drugs that include the illicit drug heroin as well as the licit prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others. These drugs work to relieve pain by interacting with opioid receptors on nerve cells in the brain and nervous system to reduce discomfort.
It is also true that these substances can be highly addictive. One in four patients with chronic pain can experience opioid dependence, according to Dr. Debra Houry, director of the CDC’s National Center for Injury Prevention and Control. Dr. Houry has been involved in the development of CDC guidelines for prescribing opioid painkillers from its inception. She also warns that a history of family addiction and/or mental health issues can put you at an even higher risk.
Many may inherently consider the illicit drug heroin to be the culprit for opioid abuse and overdose, but of the 20.5 million cases of Americans aged 12 or older who had a substance abuse disorder in 2015, two million of them involved dependence on prescription pain relievers, while just 591,000 involved abuse of heroin.
If those statistics weren’t harrowing enough, consider the following numbers relating to opioid abuse nationwide:
- Drug overdose is the leading cause of accidental death in the U.S. with 55,403 lethal overdoses in 2015 — 36% relating to prescription pain relievers and 23% relating to heroin.
- The overdose death rate nearly quadrupled from 1999 to 2008.
- Sales of prescription pain relievers quadrupled from 1999 to 2010.
- The prescribing rates for prescription opioids among adolescents nearly doubled from 1994 to 2007.
- In 2012, 259 million prescriptions were written for opioids, which equates to more than enough to provide every individual American adult with his or her own bottle of pills.
Many are attributing these alarming increases to our cultural shift toward instant gratification. “In retrospect, we were an addicted nation waiting to happen,” Baxter asserts. “We are set up for addiction because we are an impatient culture that fears aging. Pills give instant reassurance that the pain won’t last, to let us ignore our mortality without the drudge of creating a coping plan.”
Recommendations from the CDC
The CDC agrees with physicians like Baxter. In response to the growing rates of opioid use disorder and opioid overdose, it released new guidelines for prescribing opioids for chronic pain in 2016.
In these updated guidelines, primary care clinicians are provided with CDC recommendations for prescribing opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life care. The recommendations encompass everything from when to initiate opioids for chronic pain, opioid selection (dosage, duration, follow-up, etc.) and assessing the risks and addressing the harms of opioid use.
Baxter maintains the importance of distinguishing acute pain from chronic pain when discussing opioid prescriptions and abuse:
- Acute pain surfaces suddenly. It may be caused by surgery, broken bones, dental work, burns, cuts or childbirth. The pain can range from mild to severe, and it can last for weeks or months. In most cases, acute pain does not last longer than six months and will disappear once the underlying cause has been treated.
- Chronic pain persists even when the injury has healed. Pain signals remain active in the nervous system for weeks, months or even years. Common complaints of chronic pain include headaches, lower back pain, cancer pain, arthritis pain, neurogenic pain and psychogenic pain. Oftentimes, unrelieved acute pain can lead to chronic pain.
The problem is not how we treat acute pain, according to Baxter. “The problem is failing to transition after the acute phase to train away established pain,” she explains. “We confuse how we treat acute pain from pain that presents a chronic issue. For chronic pain, we need a plan, not a pill.”
The benefits of non-pharmacological treatment
Dr. Houry has shared that the purpose of the new CDC guidelines was to encourage primary care providers to maintain open dialogues with patients regarding the risks and benefits of opioids. Instead, non-pharmacological options should be considered the first-line treatment for pain.
One prominent drawback to crafting non-pharmacological treatment plans can be the time it takes to yield actual results. But as Baxter points out, pain relief is a process, not a prescription. Athletes, for example, often change multiple variables to train away the pain.
“To a dancer, a runner or any elite athlete, pain is a signal that something isn’t right and needs fixing,” Baxter explains. “We need to understand pain as an inevitable challenge of living. It’s something to be worked through, a sign of active vitality, of risk-taking, a message to change behavior or an expected part of what will happen after surgery or an injury.” In the same way that we train to achieve a goal, she adds, we should be prepared to train to alleviate pain.
It is always important to consult a healthcare professional who can help determine the right pain management plan for you. Some non-pharmacological approaches to pain relief they may recommend include the following:
- Physical therapy
- Chiropractic care
- Cognitive behavioral therapy
It’s time to join the movement
While the CDC recognizes that prescription opioids are appropriate in certain cases — including cancer treatment, palliative care and end-of-life care — the efforts to alleviate opioid dependence have led many to consider physical therapy as a go-to method of pain management. In fact, the American Physical Therapy Association (APTA) is one of the many organizations joining White House efforts to address prescription drug abuse.
APTA’s #ChoosePT campaign urges Americans to stop risking their health in an effort to be pain free. Don’t just mask the pain; treat it.
With more people turning to physical therapy as an option for pain management, it’s not surprising that it’s among the most in-demand career paths for aspiring healthcare professionals. In fact, three of the 20 fastest growing occupations identified by the Department of Labor belong to the field of physical therapy!
If you’re interested in working in healthcare, now could be the time to truly consider a career in physical therapy. Learn more by visiting our article, “New report: The future looks bright for physical therapy majors.”
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