The dependence on opioids is a problem in the United States. There has been much talk about alternatives to opioids, but despite the rhetoric, things don’t seem to change. I came across an article in the New York Times Health section that covered this topic specifically. The title caught my eye…“New Ways to Treat Pain Meet Resistance”. I thought I may be reading about some new, cutting edge approaches to the management of pain and ways to avoid opioid abuse. Instead, what I read is that physical therapy is considered an “alternative approach” by many and lumped in with a number of approaches without strong research to support their success in dealing with pain. I guess it really shouldn’t have come as a surprise. As a physical therapist with over 25 years of experience, I often hear about people that have NEVER been referred to physical therapy for their neck, back or joint pain. Despite copious amounts of research touting the benefits of exercise in reducing pain and disability, people are still quick to take the pill (or the shots), hoping that it will be the quick fix they are looking for and they won’t have to put in the hard work.
In the NYT article, the patient interviewed had neck and back pain from a motor vehicle accident. Although they didn’t delve deeply into his history, it appears that he was seen by a “pain specialist” who put him on a combination of muscle relaxants and opioids to dull the pain. It wasn’t until the patient started to have serious issues with dependence on the drugs that he was referred to any type of a physical therapy program. At that time he had to enroll in a 6 hour a day program (which involved physical therapy as well as other approaches) at a cost of $20,000. I might be biased, but maybe if the “pain specialist” had referred to PT first, there would have never been the need for an intensive detox program.
There are obviously cases where opioids are the best choice. Cases where people are having life altering pain or end of life illness and the only thing they can do is dull the nerves and block the pain. Where opioids are generally not needed are for patients with neck, back and joint pain. In most of these cases the pain is due to some inflammation, muscles spasms and inactivity. Getting patients to use an ice pack, some over the counter anti-inflammatories and getting them in a GOOD physical therapy program that utilizes the latest in evidence based practice, specific manual techniques in combination with custom, guided exercise programs is a much better approach than getting them hooked on drugs.
Gladly , the article does go on to discuss how effective physical therapy can be in helping patients eliminate pain and return to life. I know first hand how it can work…I have been helping people get pain free and return to their lives for 25 years!
If you or someone you know is suffering from chronic neck, back or joint pain and your only treatment so far has been medication, do yourself a favor and give physical therapy a try. We shouldn’t be considered an “alternative” treatment for pain…we should be considered THE treatment for pain!