• Pain medication versus physical therapy

    Pain medication versus physical therapy

    The use, overuse, and outright abuse of opiate pain medications in the United States continues to rise.  Many of us know of someone who has become addicted to such meds.  The local and national news reports daily on stories of overdose death, or crimes committed in an attempt to acquire more pain pills (i.e., pharmacy holdups).  For some, prescription opiate medications are the gateway drug towards more illicit opiate substances such as heroin.  Opiate pain meds, although sometimes necessary and helpful in the short term, can lead to problems for some.  According to the Centers for Disease Control (CDC), since 1999 the rate of overdose deaths involving opiate pain medications, including prescription pain relievers, have quadrupled.  From 2000 to 2014 nearly half a million people died from drug overdoses (78 Americans die every day from an opiate overdose).

    There are many effective non-pill options for the treatment of pain, including physical therapy, which don’t carry the dangerous risks of opiate meds.  Most Americans are unaware of their options when seeking to reduce or resolve pain.  Worse still is how often pain meds are prescribed to patients by the physicians with whom they entrust their care.  According to the CDC, an estimated 20% of patients entering physician’s offices with non-cancer pain symptoms are prescribed opiate pain meds.  In 2012, health care providers wrote 259 million prescriptions for opiate pain medication, enough for every adult in the United States to have a bottle of pills.

    The Centers for Disease Control (CDC) recently released guidelines for the usage of opiate pain medications for the treatment of chronic pain.  The guidelines recognize that prescription opiate pain medications, when properly dosed, are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, but for other pain management, the CDC recommends non-pharmaceutical treatment approaches to pain management, including physical therapy.

    The CDC guidelines outline the following regarding the non-pharmaceutical treatment of pain, including the use of physical therapy.  Physical therapy has been shown to be effective in the treatment of low back pain, as well as knee and hip pain associated with osteoarthritis, and fibromyalgia.  Non-pharmaceutical therapy, including physical therapy, is the preferred method of treating chronic pain.  In cases when opiate pain medication is used in treating chronic pain, the medication should be combined with non-pharmaceutical therapy, including physical therapy, as appropriate.

    The long-term use of opiate pain medication often begins with the treatment of acute pain. When using such pain meds to treat acute pain (i.e., following recent injury or surgery), physicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require such strong medication (three days or less will often be sufficient; more than seven days will rarely be needed).

    For the treatment of chronic pain, the CDC recommends that prescribing physicians establish treatment goals with their patients before initiating the use of opiate pain medication.  Such goals should include objectives for reducing pain and restoring function and should also consider how opiate therapy will be discontinued if benefits do not outweigh risks.  It is recommended that physicians prescribe the lowest effective dosage of immediate-release opiates instead of extended-release/long-acting medications.  Patients should continue the use of opiate pain medications only if there is clinically significant improvement in pain and function.