Say No to Drug Therapy for Chronic Pain. Choose a Physical Therapist.

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     The incidence of chronic pain is on a steady rise and chronic low back pain is one of the most common contributing conditions. Studies suggest the “the global number of individuals with low back pain is likely to increase substantially over the coming decades.”(1) The World Health Organization lists low back pain as one of the most debilitating conditions worldwide, but “the causes of lower back pain are rarely addressed.”(2)

     The prescribing of opioids has long been the approach to dealing with chronic pain, and studies show that “more than half of regular opioid users report [having] back pain.”(3) The prevalence of opioid use has increased so much over the years that the Centers for Disease Control and Prevention released a document intended for those medical doctors prescribing medication for chronic pain. This document is titled the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.

     The CDC states, that “in 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.”(4) The CDC also states, that “the overall prevalence of common, predominantly musculoskeletal pain conditions that can be chronic (e.g., arthritis, rheumatism, chronic back or neck problems, and frequent severe headaches) was estimated at 43% among adults in the United States.”(4) These are musculoskeletal conditions that physical therapists have expert knowledge of.

     The CDC guidelines endorse conservative management, stating that "based on contextual evidence, many nonpharmacologic therapies, including physical therapy… can ameliorate chronic pain.”(4) Numerous studies support the use of physical therapy for chronic low back pain and this may include the use of specifically targeted exercises, lumbar stabilization programs, physical therapy mobilizations, and many other treatment options.(5,6) A good physical therapist will aim to treat the underlying causes of pain or help put together a maintenance program, because yes some conditions may require life-long management.

     Also important to note that yes some musculoskeletal conditions may require medication intervention, but conservative treatment by a qualified physical therapist should be sought first.

- Patrick Berner, SPT

 

References:

1. Hoy D, Bain C, Buchbinder R, et al. A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism. June 2012;64(6):2028-2037.

2. 6.24 low back pain, World Health Organization. 6. Priority diseases and reasons for inclusion. http://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf. Accessed January 23, 2016.

3. Deyo R, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ (Clinical Research Ed). January 5, 2015;350: g6380.

4. Dowell D, Haegerich T, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. Atlanta, GA: CDC; 2016.

5. Specific rehabilitation exercise for the treatment of patients with chronic low back pain. Journal Of Physical Therapy Science. August 2015;27(8):2413-2417.

6. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients. Journal Of Physical Therapy Science. December 2015;27(12):3843-3846.

Physical Therapy First Lowers Cost

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     In honor of PT Day on Capital Hill, I wanted to briefly share the results of two recent research studies. The first focuses on the cost in regards to new onset of low back pain and whether patients first utilized physical therapy or advanced imaging. The second looks at physical therapy vs. surgery for lumbar spinal stenosis.

     As evidenced by this research study, utilizing physical therapy first is the most efficient and effective way to manage a musculoskeletal condition. Unlike a physical therapist, medical doctors to do receive the extensive knowledge and training in how the human body moves. 

Diagram to help depict the path a patient can take. I do not have the research for the numbers provided here.

                            Click image to enlarge the abstract.

     As evidenced by this research study, a conservative management approach was just as successful as surgery. There is a time and place for surgical procedures; however, a vast majority can be prevented with physical therapy. 

                              Click image to enlarge the abstract.

     The bottom line is that physical therapists are the musculoskeletal experts and deal with conditions of movement, involving muscles, tendons, ligaments, bones, etc. Physical therapy has shown to significantly decrease healthcare cost, which is a massive problem in our country. The profession should have direct access nationwide and the research evidence is vast to support this. For those of you who do not know, direct access is when a patient can see a physical therapist first without needing a doctor’s referral. Physical therapists are trained to recognize conditions outside their scope of practice and when to refer to a medical doctor.

     Check out this link to see where your state stands on direct access. Direct Access Summary by State.

      Regardless of your state’s direct access laws, remember that you have the right to choose your physical therapist.

 - Patrick Berner, SPT