The Opioid Epidemic and the Physical Therapists’ Role

The opioid crisis has grown in the United States since the early 2000s, when pharmaceutical companies began marketing commonly prescribed opioid medications like Oxycodone as a treatment for chronic pain and musculoskeletal conditions.

Through the early 2000s, overdose deaths in the United States from prescribed opioids skyrocketed, peaking in 2011 with almost 5 deaths per 100,000 in the US population. As awareness of the opioid epidemic grew, deaths from commonly prescribed opioids began to plateau, although illicit drugs and synthetic opioids like heroin and fentanyl have begun to fill the gap and the overall death rate from any type of opioid has continued to rise. In 2020 during the COVID-19 pandemic, there was a 30% increase in opioid overdose deaths, representing the sharpest increase in deaths in three decades. It appears the opioid crisis is here to stay.

Lack of Evidence: Opioid Prescriptions for Chronic Pain

Despite the increased use of opioids to manage chronic pain in the United States, little evidence has been shown that these drugs show any improvement in pain or quality of life in patients taking them. A 2018 randomized trial in the Journal of the American Medical Association compared 12-month outcomes on patients with chronic pain prescribed with opioid or non-opioid medications.

Not only did the non-opioid group suffer significantly fewer medication-related side effects than the opioid group, but they also had significantly lower pain intensity and similar function to the patients receiving opioids. The authors of this study concluded that treatment with opioids was not superior to treatment with non-opioid medications for improving pain-related function over a 12-month period.

Another 2015 study in the Journal of Occupational and Environmental Medicine showed a significant difference in the number of Workers’ Compensation claims that exceeded a cost of $100,000 when the patient was given opioid medications within the first 60 days of care.

How Can Physical Therapy Help Combat the Opioid Crisis?

Physical therapy can be a safe alternative to the use of opioids when treating chronic musculoskeletal pain. A 2018 study in the Journal of the American Medical Association looked at a cross-sectional analysis of 88,985 medical claims with a new diagnosis low back, shoulder or knee pain. Of the patients that received physical therapy in the first 90 days (29.3% of cases), there was a significant difference in the patients that needed opioid medication when compared to similar patients that did not receive physical therapy in the first 90 days. In addition, patients that were seen in physical therapy in the first 90 days and were prescribed opioids needed significantly less in terms of dosage (referred to as morphine equivalents) as compared to the group not receiving physical therapy.

The Centers for Disease Control (CDC) released opioid guidelines in 2016 and stated that opioids should be used sparingly, most specifically in cases of cancer treatment, palliative and end of life care, and in certain acute situations if properly dosed.

The CDC went on to recommend physical therapy in cases where the risks of opioids outweigh the reward because patients want to do more than just mask pain in chronic pain conditions. They cited high-quality evidence that physical Therapy is effective for most musculoskeletal conditions, but most specifically low back pain, hip or knee arthritis, and fibromyalgia.

Physical therapists are trained in performing thorough musculoskeletal evaluations and are able to design condition-specific treatment plans to help patients deal with their pain in a safe and effective manner. Treatment plans consist of but are not limited to exercise, manual therapy, stress management, sleep hygiene, and pain neuroscience education. Physical therapists are looking to design these treatment plans with the intention of getting to the root causes of the patient’s pain. As opposed to providing a short-term solution like an opioid medication, therapists are trying to provide strategies for actively managing and preventing future pain issues.

The Opioid Epidemic and Physical Therapists’ Role: How Upstream Rehabilitation Can Help

At Upstream Rehabilitation, our physical therapists are specifically equipped to treat patients in pain. Our patients see the same physical therapist at each visit which optimizes the therapeutic alliance and allows for continual assessment throughout treatment and progression of care.

Upstream physical therapists design individualized treatment plans with an emphasis on manual therapy, exercise, and patient education, ensuring patients receive the most up-to-date, evidence-based care.

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8. Eric Sun, MD. “Early Physical Therapy and Long-Term Opioid Use among Patients with Musculoskeletal Pain.” JAMA Network Open, JAMA Network, 14 Dec. 2018, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2718095.
9. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, https://www.cdc.gov/.
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