According to the Centers for Disease Control and Prevention (CDC), overdose deaths involving prescription opioids have quadrupled since 1999, and so have sales of these prescriptions. From 1999 to 2015, more than 183,000 people have died in the U.S. from overdose related to subscription opioids.
Just as the opioid crisis didn’t occur overnight, it certainly can’t be solved overnight – it will take monumental efforts on many fronts. To reduce the number of opioids prescribed, stem the tide of opioid abuse and addiction and stop the senseless deaths from opioid overdose requires a multifaceted approach.
In releasing its guidelines for prescribing opioids for chronic pain the CDC cited data from one study that found among 15 to 64-year-olds who received opioids for non-cancer pain, 1 in 550 died from an opioid-related overdose at a median of 2.6 years from their first prescription.
In this, the third in a series of articles Well-Being has done on the opioid crisis, we focus on physical therapy, one of the many ways healthcare providers and informed patients and their family members can address pain management by means other than prescription opioids. Well-Being spoke to Graham C. Calvert, M.D., Neck and Back Specialist and Alan Whitfield PT, DPT, ATC/LAT, Director of Rehabilitation Services, both of Mississippi Sports Medicine & Orthopaedic Center (MSMOC), about how for many individuals who experience chronic pain, undergoing physical therapy before taking prescribed opioid painkillers may actually reduce pain and rebuild physical function faster, without the risk of opioid abuse and addiction.
The CDC states that opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapy, on the other hand, treats pain through movement while encouraging patients to improve or maintain their mobility and quality of life.
The potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.
According to Dr. Calvert, that is the approach that is taken at MS Sports Medicine.
“Our protocol calls for OTC anti-inflammatories and physical therapy as a firstline agent for pain management in the treatment of pain from an injury or a chronic condition,” notes Calvert. “At select intervals, we may employ steroids, as well.”
“When other methodologies have not been successful in relieving or reducing chronic pain, we have long-established boundaries for prescribing opiates,” Calvert continues. “The seriousness of the national opioid epidemic is always top-of-mind. Most often, any opiate prescription should last only a few days and be written for the lowest dosage available.”
“In my opinion, opiates are often over-prescribed (and often are completely unnecessary) considering they can so readily lead to an addiction when used without discrimination, adds Calvert. “In instances where, anti-inflammatories, physical therapy and/or steroids are ineffective on a patient’s non-operative musculoskeletal pain, I would refer a patient to a pain management specialist before prescribing an opiate.”
According to the American Academy of Pain Medicine, millions suffer from acute or chronic pain every year and the effects of pain exact a tremendous cost on our country in health care costs, rehabilitation and lost worker productivity, as well as the emotional and financial burden it places on patients and their families.
“In The Therapy Center at MSMOC, most chronic pain that comes in our doors is related to the neck and back,” explains the Center’s Director of Rehabilitation Services, Alan Whitfield. “Of course, anyone over age 50 is likely to have some lower back pain. Next in terms of the number of complaints are shoulder injuries and/or rotator cuff tears, along with knee or hip replacements.”
Researchers suggest using a graded approach based on pain tolerance to slowly increase function, rather than using drugs to kill the pain.
“When it comes to treating these common sources of chronic pain, the CDC’s number one recommendation is non-pharmacologic (physical therapy) followed by NSAIDs, such as Advil. Recent studies show sustained pain relief for 2 to 6 months. The earlier physical therapy begins, the greater the degree of pain relief. PT provides rehabilitation that strengthens and stabilizes joints and reduces pain. It also educates patients to avoid further inflammation, aggravation and subsequent pain.”
Graham C. Calvert, M.D., Orthopaedic Surgeon at Mississippi Sports Medicine and Orthopaedic Center, received his Doctor of Medicine from the University of Mississippi School of Medicine and he completed his Orthopaedic Surgery residency at the University of Alabama in Birmingham. Dr. Calvert also received specialty training in Spine Surgery, completing a combined Neurosurgery and Orthopaedic Spine Surgery Fellowship at the University of Utah Medical Center in Salt Lake City, Utah.
Alan Whitfield, PT, DPT, ATC/LAT has served Mississippi Sports Medicine and Orthopaedic Center, as Director of Rehabilitation Services since the inception of The Therapy Center in 2005. He has practiced as a physical therapist in various settings and as an athletic trainer since 1998. Whitfield graduated Cum Laude from the University of Mississippi Medical Center with a Bachelor of Science degree in physical therapy, followed by a Doctor of Physical Therapy.