Choosing Physical Therapy over Opiates for Pain Management

Choosing Physical Therapy over Opiates for Pain Management

116 million Americans suffer from chronic pain1. Historically, opioids were thought to be a safe and effective way to manage acute and chronic pain. However, more recently, we have become more aware of the serious consequences that have evolved from overutilization of these drugs. Potential side effects of opioid use include depression, overdose, addiction, and withdrawal when stopping use2. Additionally, opioids have not been found to significantly improve long-term health outcomes. Opioids are a classification of drugs that includes hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), tramadol, oxymorphone (Opana), fentanyl, and methadone, which are commonly prescribed for varying severities of pain.2

Overutilization of opioids for pain management has become a very concerning issue in our country. The National Survey on Drug Use and Health has reported that the number of first time abusers of opioids increased from 628,000 in 1990 to 2.4 million in 2004.3 According to data published by the US Department of Health and Human Services, at least 2 million Americans have disordered opioid use involving prescribed medications, and about 90 Americans die each day from opioid overdose (including prescribed and non-prescribed substances)1. “The quantity of opioid prescriptions in the United States is staggering, with the CDC reporting 259 million prescriptions written in 2012, enough for every single American adult to have a bottle of pills.1”

When appropriate, doctors prescribe opioids to treat pain because they interrupt pain signals to the brain, inhibiting the perception of pain in the body. In proper doses, opioids are an appropriate pain management tool in some cases, most commonly utilized to get through a short duration of severe pain, as in after surgery or injury. However, they have not been found to be an effective tool for long-term pain management, and the CDC recommends other approaches like physical therapy in most cases. While pain medications reduce pain by masking it, physical therapy can help to alleviate pain by addressing the cause or source of the symptoms, without the harmful side-effects

In a recent randomized controlled trial involving 240 patients with moderate-severe chronic back, hip, and knee pain, treatment with opioids was not found to be superior to non-opioid treatments.1 In another study, receiving physical therapy as the first intervention after onset of low back pain reduced the likelihood of receiving an opioid prescription by 87% compared with patients who never received PT services.3 Physical therapy treats pain through movement, utilizing internal pain relief mechanisms and retraining the body to improve or maintain mobility and quality of life. We utilize education, hands-on care, and movement-based interventions. Due to overwhelming evidence, the CDC now recommends nonpharmaceutical approaches for treatment of chronic pain, such as physical therapy.1

Physical therapy is one of the safest and most effective alternatives to drugs for pain management. Management of acute pain is key to avoiding the progression to persistent pain. Addressing pain quickly can be an important factor. In a study about work-related injuries, same-day access to physical therapy after injury led to faster recovery, lower healthcare costs, and less time away from work.1 As physical therapists, our job is to educate people about their current condition to reduce fear and apprehension, and help them to address and manage their symptoms to prevent symptoms from becoming chronic or recurrent.

78% of Americans surveyed prefer drug-free pain management to opioid-based treatments1, and we agree! There is a better way. Try PT first!

1. Mintken PE, Moore JR, Flynn TW. Physical Therapists’ Role in Solving the Opioid Epidemic. JOrthop Sports Phys Ther 2018;45(5):349-353.
2. “Physical Therapy vs Opioids: When to Choose Physical therapy for Pain Management”. Move Forward PT. APTA, 2018,
3. Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions. Experiemental and Clinical Psychopharmacology. 2008;16(5):405-416.
4. “Health Center on Opioid Use for Pain Management: Physical Therapist Services to Avoid Opioids”. Move Forward PT. APTA, 2018.