Try Physical Therapy FIRST – an Alternative to Opioids for Pain Relief

By John R. Mishock, PT, DPT, DC

An estimated 100,000 Americans died of a drug overdose this year, a never-before-seen milestone according to the Center for Disease Control and Prevention (CDC, 2021). Experts believe that the increase in deaths is due to the growing use of fentanyl, an opioid prescription drug that is typically used for pain relief, that is mixed with other illegal drugs. Often the early utilization of pain medications can lead to a transition to heroin, fentanyl, and other hard-core street drugs and a lifelong battle with addiction. (CDC, 2018) In health care, this is why it is essential to use non-pharmacological treatments such as physical therapy first when muscle and joint injury occurs.

Approximately 75 million adults suffer from pain on a daily basis in the United States, costing an estimated $635 billion in both direct and indirect costs. (Gaskin et al. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education, 2018)

Unfortunately, the standard of care for muscle and joint pain has historically been a pharmacological approach that heavily included the use of opioid analgesics. (Rosenblum et al. Clin Pharm. 2016) However, this is contrary to the best scientific evidence and the CDC Guideline for Prescribing Opioids for Pain. The CDC reports that there is no evidence to support the benefit of long-term opioids use for musculoskeletal pain. The CDC and National Institutes of Health (NIH) guidelines for pain and opioid use explicitly state that nonpharmacological therapy, such as physical therapy or nonopioid pharmacological therapy is preferred for pain.

Try Physical therapy 1st for pain relief and improved function:

Physical therapy is widely used for the mitigation and resolution of acute and chronic pain, and recent literature suggests that PT may play a valuable role in the initial onset of pain as well as chronic pain relief. In contrast to opioids, PT is widely regarded as a safe cost-effective low-risk treatment for acute and chronic pain.

In a recent study involving physical therapy and the treatment of musculoskeletal pain (low back, hip, neck, shoulders, knees, foot, and ankle), 77.3% of patients in this sample demonstrated a decrease in pain after physical therapy intervention along with a decrease in utilization of opioid use. (Pullen et al. Bioresearch, 2020)

Opioids act by overriding or masking the pain signals. Physical therapy in contrast works at finding and treating the underlying or root cause of the pain. The physical therapist uses a wide variety of techniques to relieve pain, improve function that ultimately returns the patient to their highest quality of life. There are a wide variety of treatments that help the patient manage their pain such as:

Physical therapy modalities (the use of cold, heat, electricity, etc) to decrease pain, improve circulation and/or help muscles relax.

Hands-On Manual Therapy Techniques (joint mobilizations, myofascial treatments, Active release technique)- techniques done by physical therapists using their hands in very precise ways to relax muscles in spasm, lengthen tight muscles, improve circulation, and optimize scar tissue development.

Graston technique/IASTM(instrument-assisted soft tissue mobilization)/vibratory therapy/cupping: to increase circulation, optimize scar tissue and facilitate healing.
Exercises (strengthening, flexibility, ROM) to improve strength and enhance optimal tissue healing. Exercise is also used as a “medicine” to relieve pain. Some of these exercises are given as a home program so that the patient can manage their pain independent of the physical therapist.

Body mechanics and posture education: This helps in understanding why the problem occurred and ways to prevent further injury.

The combination of the above techniques can relieve pain and improve function and reduce opioid use thereby improving quality of life. The bottom line, try physical therapy first instead of opioids and other pharmacological approaches.

Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He uses the combination of the two to help his patients.

He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon.

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