Physical Therapy: Fighting the Opioid Epidemic

If you or someone you know is struggling with chronic pain and have not tried physical therapy, contact us today to schedule your initial evaluation.

BY MARGARET DANILOVICH, OPINION CONTRIBUTOR FOR THE HILL 5/04/17

With addiction and overdose rates rising, our country, as it’s been widely reported, is facing an opioid epidemic. Certainly, there are those who need to use prescription opioids as part of a comprehensive medical treatment plan. But even using pain pills for a short time increases the likelihood of getting addicted.   

To combat opioid addiction, we need fewer people using  opioids in the first place. And, there’s a simple and easily-implemented solution right in front of us that would save time, money and, perhaps, lives. 

A Washington Post-Kaiser Foundation survey found people are not well educated on non-pharmacological pain management strategies. Only 62 percent received physician education on pain management strategies not involving drugs, 20 percent were not told about drug side effects, including addiction, and 34 percent who took pain medication for as little as two months became addicted.

It would be easy to blame physicians for over-prescribing and under-educating patients. However, when standing face-to-face with a person in pain desperately seeking a solution, it’s understandable why someone would prescribe a pill in hopes of providing immediate relief. And in a time of greater financial pressures on the healthcare industry, the lack of time with patients limits the ability to educate on the many issues surrounding pain management, much less options that don’t involve prescription drugs.  

But, the plot thickens further: almost 20 percent percent of health care visits are related to musculoskeletal problems — think back pain, arthritis, neck discomfort. Yet, primary care physicians are not optimally trained to care for patients with musculoskeletal problems: only 20 percent of medical schools have a mandatory musculoskeletal clerkship and less than half have a required musculoskeletal course. The lack of training leads to decreased confidence and ability to diagnose and manage problems in this area.

However, physical therapists are healthcare providers with specific training in musculoskeletal conditions. With this expertise, physical therapists are skilled at identifying, diagnosing, and treating movement problems, including pain.

So, here’s a simple solution to the opioid epidemic: to reduce the use of opioids to manage pain, people should have greater access to physical therapists.

Physical therapists are the most well-trained health care provider to address pain and prevent unnecessary opioid use, but unfortunately, are often under-referred and underutilized. In fact, direct access to a physical therapist is the model at most US military hospitals and clinics. 

A recent study found that only 10 percent of patients with low back pain who visited a primary care physician between 1997 and 2010 were referred to a physical therapist. Meanwhile, during this same period, prescription rates for opioids rose from 15 to 45 percent.

Despite the CDC recommendation of physical therapy in the treatment of chronic pain, the lack of physician referral prevents patients in accessing timely and effect physical therapy care. And, our focus on the immediacy of prescription pain relief rather than long-term pain management strategies not involving medication has led us down a dangerous path, medically and culturally.

We can remove these barriers to care, and start to lessen our “quick fix” thinking, by removing the physician referral mandate. Allowing people to enter the healthcare system directly by seeing a physical therapist without a physician referral will provide patients effective care without delay. 

Some may argue that physical therapists are not sufficiently educated or trained to identify or diagnose a pathologic condition. As an instructor at Northwestern University’s Feinberg School of Medicine, I say otherwise.

Our students earn a clinical doctoral degree in physical therapy, undertaking a rigorous full-time three-year program of basic science and applied science courses. Physical therapy doctoral students spend an average of 1,200 hours in the clinic practicing even before graduation, preparing them to provide the optimal care for pain and other movement problems.

Direct access to physical therapist services is safeimproves health outcomes, and decreases healthcare costs. In a time with unmanageable healthcare costs, staggering rates of dependence on prescription drugs, and lives at stake every day that we continue on without a long-term solution to the opioid crisis, better utilizing physical therapists as the highly trained musculoskeletal experts they are immediately puts us on a path to healthier patients and a more cost-effective healthcare system.

Margaret Danilovich is an instructor at Northwestern University Feinberg School of Medicine – Department of Physical Therapy and Human Movement Sciences. She is a Public Voices Fellow in The OpEd Project.