The American Physical Therapy Association (APTA) has released several alternatives on how hands-on PT might replace pain meds.

The campaign to replace pain meds with PT is getting some negative buzz from opioid manufacturers but they, as well as others in the field, have some valid, statistical research on how PT can work better than pain meds. As with most issues, there are two sides to all opinions. This is how Excellence in Rehabilitation feels.

I’m not taking the stand that opioids should NEVER be used and that we should replace all pain meds but the CDC released opioid prescription guidelines in March 2016 recognizing 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—and it’s a big if—properly dosed.

So when could PT be considered to replace pain meds?

  1. Consider alternatives if opioids have high risks: Opioids can cause addiction, overdose, and withdrawal. Explore safer options first.
  2. Chronic pain (over 90 days): For chronic pain, non-opioid therapies are preferred. Physical therapy can improve pain and function with lower risk.
  3. Mental health concerns: People with mental health issues are at higher risk for opioid misuse. Consider physical therapy as an alternative.
  4. Reduce pain without medication: Physical therapy can reduce pain for knee, shoulder, neck, and low back pain, potentially lowering opioid use.
  5. Follow expert guidelines: The CDC recommends non-opioid treatments like physical therapy for chronic pain management.

One review of the research from Oregon Health and Science University found that rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. “Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care.” And for chronic back pain, there is “scant evidence of efficacy…Opioids seem to have short-term analgesic efficacy for chronic back pain, but benefits for function are less clear.”

According to the APTA, part of the problem with patients seeking PT is the barrier to entry. APTA says current policies make PT harder to access than opioids. Insurance & referrals create delays, while co-pays for PT can be higher than the price of opioids. And the Duke Clinical Research Institute says high co-payments can also be a barrier—often, the co-payment for a one-month opioid prescription is less than the co-payment for a single session with a chiropractor or physical therapist.

Based on this data and my 20+ years as a Physical Therapist and Instructor in the field, the biggest takeaway is that early Physical Therapy may be an option for several musculoskeletal conditions. If preventing long-term opioid use is a treatment goal, the research all supports that those receiving early Physical Therapy had fewer long-term opioid use rates.

If knowledge is power, that’s important information for Physical Therapists to have in their treatment toolbox.

Call Brian Scherff with any questions at 269-569-4414 or email Brian here. See The MAT Table live in action and learn more here.



Tags: inversion table, MAT, MAT Table, Physical Therapy, Physical Therapist, Replace Pain Meds, Vestibular Physical Therapy.