The 16th-century philosopher Francis Bacon once observed that on many occasions, “The remedy is worse than the disease.” And this would seem to be the case, at least when it comes to prescribing narcotics to treat injuries, only to discover that the “cure” has surpassed the pain it was supposed to treat and becomes a major problem unto itself.
In response to a growing opioid epidemic, the Centers for Disease Control and Prevention released opioid prescription guidelines in March 2016. The CDC recognizes that prescription opioids are appropriate in certain cases, including cancer treatment and also in certain acute-care situations, if properly dosed. But for other pain management, the CDC recommends nonopioid approaches, including physical therapy, whereas:
• The risks of opioid use outweigh the rewards.
Potential side effects of opioids include depression, overdose and addiction, plus withdrawal symptoms when stopping opioid use.
• Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia. The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for these familiar conditions.
• Opioids are prescribed for pain.
Even when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with nonopioid therapies, such as physical therapy.
Physical therapists are uniquely situated within our health care system to see patients with a frequency rarely encountered elsewhere. This allows for an emphasis on teamwork and quality one-on-one interactions. It’s as simple as night and day; opioids mask pain, physical therapy is designed to cure pain. It doesn’t always work, but there’s more upside than downside. The upside is eventually you will be able to live a productive, pain-free life. The downside needs no explanation.
During the time an injured party is still in pain and may be looking for a quick fix, doctors are often willing to accommodate. Feel a pain, take a pill.
Still, doctors aren’t the villains here. Besides being busy and overworked, they are doing what they have been trained to do … ease suffering. Yet according to the American Society of Anesthesiologists, “A physical therapist that specializes in physical medicine and rehabilitation may be able to create an exercise program that helps you improve your ability to function and decreases your pain.”
This means, if a physical therapist can get involved in the process quicker, they may be able to offer alternatives.
Our industry isn’t perfect. There are lazy doctors, lazy accountants, lazy lawyers, and, certainly, lazy physical therapists. The key is to do your due diligence. The time spent doing that, and the prospect of finding a PT that has the tools needed to understand your pain and will work with you to put the pieces of your life back together, will certainly outweigh a very scary alternative.
Fortunately, even the medical profession appears to be coming around to the idea that there may be an alternative to fast-tracking narcotics as the answer to injuries.
“Exercise, physical therapy and talk therapy have proven benefits in the areas of making the body work better, and coping. Health care providers ought to approach long-term pain with a combination of those treatments,” said Ellen Edens, a psychiatrist who treats veterans with chronic pain and long-term opioid use in the VA Connecticut Healthcare System.
It’s a sad state of affairs that something as basic as a lower back injury from lifting boxes in a warehouse, or a shoulder pain caused by washing your living room windows, can lead to potential opioid addiction. Perhaps now is the time to seek an alternative route. n
Shawn Cray is the founder of Cray Physical Therapy, with offices in Weymouth and Braintree, Mass.
