Part 4 of 4: Physical Therapy First
Throughout this series, we’ve covered musculoskeletal disorders, the opioid epidemic, why painkillers are so addicting, where the majority of disabilities originate from, and challenges navigating the healthcare system. But one question is left, what can we do about it? As it turns out, there is quite a lot, both at an industry level and on a personal level.
The American Medical Association has been advocating for the removal of barriers and increased access for the public to personalized evidence-based care. The healthcare industry is a slow-moving giant, so major changes to processes and attitudes take time. The industry is currently profiting tremendously from these inefficiencies which makes them less interested in change. During this time, the patient and their pocketbook continue to suffer, but over the last 10 years we have seen progress. One of the major wins, Direct Access, gave the public more first-stop healthcare options without a referral. But we still face roadblocks from insurance and local governments limiting the full benefits of Direct Access.
The hype around painkillers, so prevalent in the 90s and 00s, has cooled and the consequences are being addressed. Doctors prescribe alternative treatments more frequently, leaving painkillers as a last resort, and even some governments have encouraged holding off on painkillers, favoring evidence-based care such as physical therapy. (Center for Disease Control and Prevention, 2017)
The biggest challenge that remains is spreading awareness about alternative options. Where do patients need to go to get proactive care? How do we show employers the waste in their healthcare spending, and how can they reduce it? What can we do to put pressure on government and insurance to remove barriers to care? We need to keep the conversation going. With hard data and communication, we can reverse this ever-spiraling cycle.
Taking Proactive Steps
Painkillers still have a role to play in healthcare, but knowing when they are appropriate and when they can be avoided is important. For patients, it’s a matter of understanding their bodies. Pain is the body responding to stimuli and should be listened to, both by the patient and the care provider. The body has an amazing healing ability and uses symptoms to alert us to potential issues. We should encourage and facilitate that healing ability and not simply mask the symptoms. This is especially true with musculoskeletal conditions. Pain doesn’t always mean damage, but it also does not always match the severity of the problem. That is why seeking out a specialist, such as a physical therapist, is an important first step to recovery.
For functional issues, removing arbitrary laws and policies that restrict patient access to multidisciplinary, multimodal pain care gives back the patients’ power to better control their health.
“To make meaningful progress towards ending this epidemic, a broad-based public health approach is required. This approach must balance patients’ needs for comprehensive pain management services, including access to non-opioid pain care as well as opioid analgesics when clinically appropriate, with efforts to promote appropriate prescribing, reduce diversion and misuse, promote an understanding that substance use disorders are chronic conditions that respond well to evidence-based treatment, and expand access to treatment for individuals with substance use disorders.”
—Gerald E. Harmon, MD, AMA President (American Medical Association , 2021)
When to Avoid Painkillers
Painkillers are best saved as last resorts. The CDC produced guidelines that recognize appropriate cases for opioid prescriptions such as cancer treatment, palliative care, and end-of-life care. Acute injuries can also merit painkillers. Because of the potential side effects of painkillers which include addiction, depression, and overdose, alternative pain management makes more sense in most cases.
Patients and physicians alike should ask themselves a few questions before deciding to use prescription painkillers. These will help decide the right path for treatment.
- Do the risks of opioid use outweigh the rewards? Because of the risk of addiction and withdrawal, painkillers are not considered good options for first line or routine treatment.
- Is the goal to do more than mask the pain? Painkillers don’t repair your body. The rate your body heals itself is unaffected by painkillers, but painkillers help alleviate temporary pain while the body is in the process of healing. If pain is not the result of a traumatic event, such as a surgery or acute injury, then painkillers will not aid in addressing the root of the problem.
- Is the pain or the functional problems related to the spine, hip or knee osteoarthritis, fibromyalgia, etc.? These are musculoskeletal disorders that should be corrected with physical intervention and not painkillers.
- Has the pain lasted 90 days or longer? At this point, the pain is considered “chronic,” and the risks for continued opioid use and possible addiction increase.
Opioids should be avoided if the risks do not outweigh the benefits for addressing pain and function, or if the patient is dealing with a chronic issue. Healthy movement and physical therapy have shown to be much more beneficial in addressing musculoskeletal and neuromuscular disorders than painkillers. (American Physical Therapy Association , 2021)
“…over the last 2 months working with these highly trained [physical] therapists and assistants I have become so strong and have been able to reduce the amount of pain medication I take. Most days I don’t require any medication at all. I would recommend them to anybody and everybody…”
—Carol B., Physical therapy patient
Time to Move!
We know how important exercise and movement are to our overall health. Movement improves cardiovascular function, brain function, balances hormones and mood, and keeps our bodies strong. Movement is also crucial in pain management and recovery. The goal of a physical therapist or occupational therapist is to break the pain cycle and identify the root cause of pain and dysfunction. Therapists can spot and correct abnormalities in the kinetic chain and strengthen surrounding muscles to support comprehensive and long-term healing. A therapist will be your partner in recovery, planning structured and unique exercises that adapt to your needs as you progress through treatment.
It is never a bad time for movement. You can visit a physical therapist whenever you need to, whether it’s for a sudden acute injury, regular visits to keep chronic issues at bay, preparation for surgery to help minimize downtime, or post-surgery to return to your life, pain-free. Physical therapists are movement specialists with a comprehensive understanding of the kinetic-chain and an arsenal of tools and knowledge to help you achieve your goals.
In order to end the nation’s opioid epidemic, we need to focus on educating one another and commit to improving access to healthcare. Spooner is dedicated to providing high quality, evidence-based care to patients in need of pain management and physical therapy. It is a commitment that we make to each other, to our patients, and to our community to improve others’ lives through movement.
Learn more about Orthopedic Rehabilitation at Spooner. Ready to #choosept first? Schedule an appointment or complimentary movement screen with a Spooner physical therapist at one of our locations throughout the valley.
Resources
- Drug Overdose Epidemic. Retrieved from American Medical Association : https://www.ama-assn.org/delivering-care/overdose-epidemic/physicians-progress-toward-ending-nation-s-drug-overdose-epidemic
- American Physical Therapy Association . (2021, August 11). Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management. Retrieved from ChoosePT: https://www.choosept.com/health-tips/physical-therapy-vs-opioids-when-to-choose-physical-therapy-pain-management
- Center of Disease Control and Prevention. (2017, September 17). U.S. Opioid Dispensing Rate Maps. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/rxrate-maps/index.html