In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March, 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed. But for other pain management, the CDC recommends non-opioid approaches including physical therapy.
When to choose physical therapy over opioids:
- The risks of opioid use outweigh the rewards. Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, "risks are much lower" with non-opioid treatment plans.
- Patients want to do more than mask the pain. Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
- Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia. The CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
- Opioids are prescribed for pain. Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with non-opioid therapies, such as physical therapy.
- Pain lasts 90 days. At this point, the pain is considered chronic, and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that non-opioid therapies are preferred for chronic pain and that clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.
As always, before you make a medication change, consult with your prescribing healthcare provider and educate yourself on all your options. Patients are also encouraged to consult with a physical therapist to discuss options for non-opioid treatment.
According to the CDC, as many as 1 in 4 people who receive prescription opioids long-term for non-cancer pain in primary care settings struggle with addiction.
Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.