America is in the midst of an opioid epidemic.
To address this national health crisis, the Centers for Disease Control and Prevention (CDC) issued guidelines in March 2016 urging providers to reduce opioid prescribing in favor of safe, non-drug alternatives such as physical therapy for chronic pain conditions. The American Physical Therapy Association (APTA) launched a national public awareness campaign to educate consumers about the risks of opioids and the safe alternative of physical therapy for pain management.
Listen in as Emily Devine, Physical Therapist at Stoughton Hospital, explains that physical therapy can reduce the need for opioid medications.
Physical Therapy Can Be A Safe Alternative To Opioids
Featured Speaker:
Emily Devine, physical therapist
Emily Devine is a physical therapist at Stoughton Hospital. Transcription:
Physical Therapy Can Be A Safe Alternative To Opioids
Melanie Cole (Host): America is in the midst of an opioid epidemic. Consider that in 2012 alone, health care providers wrote 259 million prescriptions for opioid pain medication—enough for every American adult to have their own bottle of pills. To address this national health crisis, the Centers for Disease Prevention issued guidelines in March 2016, urging providers to reduce opioid prescribing in favor of safe, non-drug therapies for chronic pain conditions. My guest today is Emily Devine. She’s a physical therapist with Stoughton Hospital. Welcome to the show, Emily. Tell us about what’s going on with this opioid epidemic that we’re seeing in this country.
Emily Devine (Guest): Thank you for having me. Yes, as you said, the epidemic is quite real and I think the fact that 1 in 4 people are receiving opioid prescriptions for non-cancer related pain ultimately do struggle with addiction. That’s quadrupled with these prescriptions going up. So, it’s definitely become an issue which is now pushing a lot of providers to look to ways of treating pain and managing pain that doesn’t include a bottle of pills, like you said.
Melanie: So, what can a physical therapist do to help offset some of this so that maybe a patient doesn’t need quite as much medication?
Emily: Sure. So, physical therapy treats painful movement through helping patients improve strength, improve their flexibility, improve range of motion. Then, we can also educate patients about pain which has also been shown to improve outcomes. Where opioids generally mask the sensation of pain, physical therapists treat pain through movement. Where opioids have a lot of different side effects which many are aware of such as depression, overdose, addiction and then really patient withdrawal symptoms, physical therapy side effects generally include improved motion, increased independence with your daily life activities, decreased pain. Then, ultimately, even prevention of other health problems that your physical therapist may pick up on or that just generally improves through improved movement and exercise. The effectiveness of opioids for long-term pain management is really inconclusive where physical therapy a lot of different conditions have shown a lot of evidence that things get better with physical therapy from low back pain to hip and knee arthritis or even fibromyalgia.
Melanie: So, when should patients choose physical therapy instead of medicational intervention?
Emily: That’s a great question. Usually, the risk of opioid risks outweigh the rewards and so when you think kind of about what we just said about the side effects of opioids, are those side effects like depression, overdose and addiction withdrawal, are those higher risks not kind of worth it? You can also, if a patient wants to not just mask the pain like an opioid does generally do, again, therapists can treat that pain through movement and you partner with your therapist to really, truly work on improving and maintaining your mobility and your quality of life. Generally, any time an opioid is prescribed for pain, most likely your physician is now going to try to give you the lowest effective dose and often they’re going to want that combined with non-opioid therapy such as physical therapy. Lastly, usually if you have what we would consider chronic pain or pain more than 90 days and you then continue use of opioids, that risk for continued opioid use increases. That’s really an opportunity for you to talk to your physician about possibly getting in to see a physical therapist to discuss different options for treatment.
Melanie: You’re talking about opioids but what about things like anti-inflammatories. We’re not putting those in the same category, obviously.
Emily: Right.
Melanie: But, can they do physical therapy and still be on such things as anti-inflammatories? Whatever that might be? NSAIDS?
Emily: Sure. Absolutely. Oftentimes, those are combined. The goal is, obviously, to try to reduce your medication need and use mobility and motion to try improve your overall well-being as well.
Melanie: So, what do you think about ice when we’re talking about some of the pain? Low back pain or hip or osteoarthritis.
Emily: Right.
Melanie: Any of those kinds of things. Are you somebody that tells your patients that one way to treat that is to ice or do you like heat? Which one?
Emily: We get that question all time, I would say. Often, it’s going to depend on which physical therapist you happen to talk to for that day. I tend to lean a little bit more on ice as I find ice to be a natural analgesic or a natural pain reliever. It not only can help with inflammation but even muscle spasms like heat would because it numbs the nerves that go to that area and you decrease the sensation, therefore. So, I tend to be more of an ice recommender, so to speak. Heat, I tend to recommend, though, for people who have arthritis or stiffness with movement or that ache as well. But, you definitely could use both. Both may work. Sometimes, I recommend ice and somebody might come back and say, “That didn’t do anything for me.” So, try heat and that’s just going to help them better. So, it is just somewhat variable from person to person, for the most part.
Melanie: So, also, when we’re talking about different ways that people can help their own pain alongside their physical therapy, what about topical analgesics? Are there any that you use, Emily, that you would recommend or that you would say, “You know what? Sometimes BENGAY kinds of things do work.”
Emily: Sure. I will say what we tend to use in our clinic and that most of our patients do feel they have good outcomes from. We use BioFreeze which is topical as well as Sombra. It’s mainly a cool feeling versus a warm feeling, also patient preference on that as well. You’ve got to remember, though, that really is just topical related so it’s not necessarily going to cure something but it may help reduce pain for certain activity or reduce pain enough so you can get a good night’s sleep.
Melanie: So, then, there are things that are more systemic like fibromyalgia.
Emily: Yes.
Melanie: People are on a lot of these opioids for those systemic pain conditions, polymyalgia, fibromyalgia. So, what do you tell them about physical therapy, in general? It seems to a lot of people when they hear “physical therapy” that’s because they have tendonitis in their shoulder or they’ve got some problem with their back but when they’re thinking systemically and something that affects many different parts, what do you do with them and what do you tell them?
Emily: Sure. Well, with regard to physical therapy, we can manage pain a lot of different ways. With regard to exercise, just general exercise can actually help, even with those chronic pain issues. They have found that, in some research in people that exercise 3 times per week and had chronic arthritis pain, were about 28% less common. So, just that statistic alone can really show that exercise can really make you feel better. Also, with physical therapy, we do things such as manual therapy. This is more that hands-on approach of treating pain. So, physical therapists can use manipulation, gentle soft tissue mobilizations or even dry needling where we do have some specialists in that field. They’ve also even shown some benefits of just simple education. Learning a little bit more about pain and what it is and how it works. Just knowing about your pain and understanding your pain history helps patients that have chronic issues, like with fibromyalgia, the realistic expectations about their treatment and then can see those successes in time.
Melanie: And, pain is certainly so subjective.
Emily: Very.
Melanie: Because the person feels it in a different way. Now, the Surgeon General sent a letter to every physician in the country recently asking for their help to solve this problem. So, the American Physical Therapy Association has launched a National Awareness campaign. Tell us just a little bit about what you physical therapists want the country to know about how you can help manage chronic pain and why they should come to Stoughton Hospital for their care.
Emily: Like I said, physical therapy does treat pain through movement and helping you improve your strength and flexibility in motion. With regard to tips to avoiding chronic pain and what a physical therapist can help you with is it can keep you moving. It can keep you moving gradually to steadily living an active, healthy lifestyle. They can also really get you into a teamwork based relationship with your physical therapist where you can actively participate in your own recovery which can ultimately impact your successes. We also like to educate people about not focusing on imaging like MRIs. In fact, there have been a lot of studies out there where they have looked at folks that have no symptoms of low back pain and found that 90% of them have had a disc bulge or something but none of them have symptoms and to really discuss with your physical therapist how to help guide you back into the lifestyle you might prefer and then to also to help you address any depression or anxiety. They’ve also shown a lot of relationships between pain and experiencing depression and anxiety. The physical therapist can actually help kind of move you in the right direction getting the right help for those things, too.
Melanie: Thank you so much, Emily. What great information and so important for the listener to hear. You’re listening to Stoughton Hospital Health Talk and for more information, you can go to www.stoughtonhospital.com. That’s www.stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.
Physical Therapy Can Be A Safe Alternative To Opioids
Melanie Cole (Host): America is in the midst of an opioid epidemic. Consider that in 2012 alone, health care providers wrote 259 million prescriptions for opioid pain medication—enough for every American adult to have their own bottle of pills. To address this national health crisis, the Centers for Disease Prevention issued guidelines in March 2016, urging providers to reduce opioid prescribing in favor of safe, non-drug therapies for chronic pain conditions. My guest today is Emily Devine. She’s a physical therapist with Stoughton Hospital. Welcome to the show, Emily. Tell us about what’s going on with this opioid epidemic that we’re seeing in this country.
Emily Devine (Guest): Thank you for having me. Yes, as you said, the epidemic is quite real and I think the fact that 1 in 4 people are receiving opioid prescriptions for non-cancer related pain ultimately do struggle with addiction. That’s quadrupled with these prescriptions going up. So, it’s definitely become an issue which is now pushing a lot of providers to look to ways of treating pain and managing pain that doesn’t include a bottle of pills, like you said.
Melanie: So, what can a physical therapist do to help offset some of this so that maybe a patient doesn’t need quite as much medication?
Emily: Sure. So, physical therapy treats painful movement through helping patients improve strength, improve their flexibility, improve range of motion. Then, we can also educate patients about pain which has also been shown to improve outcomes. Where opioids generally mask the sensation of pain, physical therapists treat pain through movement. Where opioids have a lot of different side effects which many are aware of such as depression, overdose, addiction and then really patient withdrawal symptoms, physical therapy side effects generally include improved motion, increased independence with your daily life activities, decreased pain. Then, ultimately, even prevention of other health problems that your physical therapist may pick up on or that just generally improves through improved movement and exercise. The effectiveness of opioids for long-term pain management is really inconclusive where physical therapy a lot of different conditions have shown a lot of evidence that things get better with physical therapy from low back pain to hip and knee arthritis or even fibromyalgia.
Melanie: So, when should patients choose physical therapy instead of medicational intervention?
Emily: That’s a great question. Usually, the risk of opioid risks outweigh the rewards and so when you think kind of about what we just said about the side effects of opioids, are those side effects like depression, overdose and addiction withdrawal, are those higher risks not kind of worth it? You can also, if a patient wants to not just mask the pain like an opioid does generally do, again, therapists can treat that pain through movement and you partner with your therapist to really, truly work on improving and maintaining your mobility and your quality of life. Generally, any time an opioid is prescribed for pain, most likely your physician is now going to try to give you the lowest effective dose and often they’re going to want that combined with non-opioid therapy such as physical therapy. Lastly, usually if you have what we would consider chronic pain or pain more than 90 days and you then continue use of opioids, that risk for continued opioid use increases. That’s really an opportunity for you to talk to your physician about possibly getting in to see a physical therapist to discuss different options for treatment.
Melanie: You’re talking about opioids but what about things like anti-inflammatories. We’re not putting those in the same category, obviously.
Emily: Right.
Melanie: But, can they do physical therapy and still be on such things as anti-inflammatories? Whatever that might be? NSAIDS?
Emily: Sure. Absolutely. Oftentimes, those are combined. The goal is, obviously, to try to reduce your medication need and use mobility and motion to try improve your overall well-being as well.
Melanie: So, what do you think about ice when we’re talking about some of the pain? Low back pain or hip or osteoarthritis.
Emily: Right.
Melanie: Any of those kinds of things. Are you somebody that tells your patients that one way to treat that is to ice or do you like heat? Which one?
Emily: We get that question all time, I would say. Often, it’s going to depend on which physical therapist you happen to talk to for that day. I tend to lean a little bit more on ice as I find ice to be a natural analgesic or a natural pain reliever. It not only can help with inflammation but even muscle spasms like heat would because it numbs the nerves that go to that area and you decrease the sensation, therefore. So, I tend to be more of an ice recommender, so to speak. Heat, I tend to recommend, though, for people who have arthritis or stiffness with movement or that ache as well. But, you definitely could use both. Both may work. Sometimes, I recommend ice and somebody might come back and say, “That didn’t do anything for me.” So, try heat and that’s just going to help them better. So, it is just somewhat variable from person to person, for the most part.
Melanie: So, also, when we’re talking about different ways that people can help their own pain alongside their physical therapy, what about topical analgesics? Are there any that you use, Emily, that you would recommend or that you would say, “You know what? Sometimes BENGAY kinds of things do work.”
Emily: Sure. I will say what we tend to use in our clinic and that most of our patients do feel they have good outcomes from. We use BioFreeze which is topical as well as Sombra. It’s mainly a cool feeling versus a warm feeling, also patient preference on that as well. You’ve got to remember, though, that really is just topical related so it’s not necessarily going to cure something but it may help reduce pain for certain activity or reduce pain enough so you can get a good night’s sleep.
Melanie: So, then, there are things that are more systemic like fibromyalgia.
Emily: Yes.
Melanie: People are on a lot of these opioids for those systemic pain conditions, polymyalgia, fibromyalgia. So, what do you tell them about physical therapy, in general? It seems to a lot of people when they hear “physical therapy” that’s because they have tendonitis in their shoulder or they’ve got some problem with their back but when they’re thinking systemically and something that affects many different parts, what do you do with them and what do you tell them?
Emily: Sure. Well, with regard to physical therapy, we can manage pain a lot of different ways. With regard to exercise, just general exercise can actually help, even with those chronic pain issues. They have found that, in some research in people that exercise 3 times per week and had chronic arthritis pain, were about 28% less common. So, just that statistic alone can really show that exercise can really make you feel better. Also, with physical therapy, we do things such as manual therapy. This is more that hands-on approach of treating pain. So, physical therapists can use manipulation, gentle soft tissue mobilizations or even dry needling where we do have some specialists in that field. They’ve also even shown some benefits of just simple education. Learning a little bit more about pain and what it is and how it works. Just knowing about your pain and understanding your pain history helps patients that have chronic issues, like with fibromyalgia, the realistic expectations about their treatment and then can see those successes in time.
Melanie: And, pain is certainly so subjective.
Emily: Very.
Melanie: Because the person feels it in a different way. Now, the Surgeon General sent a letter to every physician in the country recently asking for their help to solve this problem. So, the American Physical Therapy Association has launched a National Awareness campaign. Tell us just a little bit about what you physical therapists want the country to know about how you can help manage chronic pain and why they should come to Stoughton Hospital for their care.
Emily: Like I said, physical therapy does treat pain through movement and helping you improve your strength and flexibility in motion. With regard to tips to avoiding chronic pain and what a physical therapist can help you with is it can keep you moving. It can keep you moving gradually to steadily living an active, healthy lifestyle. They can also really get you into a teamwork based relationship with your physical therapist where you can actively participate in your own recovery which can ultimately impact your successes. We also like to educate people about not focusing on imaging like MRIs. In fact, there have been a lot of studies out there where they have looked at folks that have no symptoms of low back pain and found that 90% of them have had a disc bulge or something but none of them have symptoms and to really discuss with your physical therapist how to help guide you back into the lifestyle you might prefer and then to also to help you address any depression or anxiety. They’ve also shown a lot of relationships between pain and experiencing depression and anxiety. The physical therapist can actually help kind of move you in the right direction getting the right help for those things, too.
Melanie: Thank you so much, Emily. What great information and so important for the listener to hear. You’re listening to Stoughton Hospital Health Talk and for more information, you can go to www.stoughtonhospital.com. That’s www.stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.