Industry Voices—Where is PT in the national debate over pain management and opioids?

Addressing the opioid epidemic has become the defining health challenge of our time.

With tens of thousands of Americans dying every year from substance use disorder, the tragic consequences of this crisis are unprecedented. Addiction tears away at the social fabric of communities across the U.S., undermining the sense of communal well-being we as citizens hold dear. 

Debates about ways to confront the innumerable ramifications of the opioid epidemic have become pervasive in our political discourse as awareness of the problem has grown. This is a positive development and has led to effective—and even bipartisan—legislative and regulatory initiatives on both the federal and state levels.

Despite these positive steps, one fundamental question underlying the crisis still remains only partially answered. As healthcare providers move away from the opioid-centered, pharmacological approach to pain management, what treatment alternatives remain to properly treat the chronic and acute pain of American patients?

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While recent legislation did acknowledge the need for nonopioid-based pain management treatments and even allocated grant funds for physicians who researched them, one important treatment alternative has unfortunately remained largely neglected in the pain management debate: physical therapy (PT). A safe and nonpharmacological form of treatment, PT has the potential to become one of the many risk-free alternatives to opioid-based pain management regimens. 

Opioid prescription guidelines published by the Centers for Disease Control and Prevention in 2016 substantiate this idea. After noting the staggering number of opioid prescriptions written over the last decade, the guideline goes on to describe the potential for nonpharmacological treatments such as PT to reduce the enormously outsized influence of opioids over pain management. PT, according to the CDC, is not only a low-risk treatment that can “ameliorate chronic pain,” but it is also less expensive and more cost-effective than opioid-based medications, offering the potential to reduce healthcare spending on drugs.

More recently, U.S. Surgeon General Jerome Adams, M.D., described PT professionals as “well-positioned to change the culture around pain management,” adding that “physical therapists are key to overcoming not only the opioid epidemic but in creating healthier societies.” 

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The growing multitude of health professionals promoting PT as a strong pain management alternative has been accompanied by burgeoning patient demand for greater access to opioid-free treatments. A 2017 Gallup poll revealed that a third of respondents believed doctor-prescribed opioids were “not very safe” or “not safe at all.” While this should come as no surprise given the staggering number of deaths caused by the epidemic, 78% of respondents also expressed their eagerness to try alternative treatments to alleviate pain. 

Patient demand wedded with enthusiasm from clinical professionals make PT a strong alternative that can reduce opioids’ perilously disproportionate role in pain management. This is not to say that PT can serve as a complete substitute to opioid-based pharmaceuticals, but rather that it is one of many alternative treatment therapies that can address chronic and acute pain without presenting the destructive risk of addiction.

As we continue to combat the opioid epidemic, we must impress upon lawmakers in Congress the importance of promoting pain management alternatives. The recent dialogue in Washington, while substantive in many ways, would have benefited greatly if a physical therapist’s voice was added to the conversation. Complex health crises require comprehensive and categorical responses. I believe PT is well-placed to be an incredibly important part of that response.

Nikesh Patel, PT, DPT, is a physical therapist and executive director of the Alliance for Physical Therapy Quality and Innovation.