Prescription Rates For Opioids Are Decreasing While Rates For Non-opioids Prescriptions Are Increasing

Try as we might, it’s nearly impossible to avoid pain altogether. Whether it’s twisted ankle or a sore neck, we all experience pain at one point or another, which is why pain is by far the most common reason people seek out health care. But treating pain—especially long-lasting, or chronic pain—is rarely easy or straightforward. Treatment often requires a multifaceted approach due to the numerous variables that contribute to a patient’s perception of pain and response to treatment.

The use of opioids to treat pain has long been controversial. Some patients, such as those with terminal illnesses and those who are on end-of-life care, may require opioids due to the extreme amount of pain they are in. Opioids may also be appropriate for a limited period for certain short-lived (acute) painful conditions; however, it’s not clear if they are also effective for patients with chronic pain. But this has not stopped medical professionals from prescribing these drugs for all types of conditions.

Starting in the late ‘80s and early ‘90s, opioids were prescribed on a major scale to individuals dealing with both acute and chronic pain. Over the years, prescribing these drugs has become a standard practice that many doctors assumed was safe and effective, even though there has always been a lack of high-quality research on the benefits and harms of opioids. As a result, opioids have been overprescribed for far too long, and at least 400,000 people have died of an opioid overdose between 1999 and 2017.

The CDC Recommended Prescribing Changes for Pain Meds

The epidemic has brought light to the situation and raised questions about prescribing these drugs to patients in pain, and professional organizations like the CDC have therefore provided guidelines on when and how to give prescriptions, and what else can be done to address this problem. One of the central messages that has been stressed by healthcare leaders in various positions is that physical therapy should be utilized as a first-line treatment and an alternative to opioids for managing pain. Here are some examples:

• In August 2016, the U.S. Surgeon General at the time, Vivek Murthy, MD sent a letter to 2.3 million medical professionals to address the opioid epidemic provide a call to action to end it. The letter was combined with an infographic to assist these professionals in the prescription of opioids, and one of the central recommendations made was to consider non-opioid therapies first, with physical therapy being listed as an important alternative.
• A task force made up of experts in various medical fields was created to establish guidelines for managing pain and the role of opioids in the process. One of the key guidelines was that restorative therapies like physical therapy should be a central component of patient care. It points out that these therapies play a significant role in managing acute and chronic pain, and that positive patient outcomes are more likely when they are used.
• In 2016, the Centers for Disease Control and Prevention (CDC) provided a set of evidence-based recommendations for opioid prescriptions, stating that opioids should only be prescribed when the expected benefits outweigh the risks, and nonopioid pain treatment should be prescribed instead of, or in addition to opioids. Physical therapy is mentioned among the nonopioid and nonpharmacologic therapies recommended because evidence shows that it can alleviate chronic pain.

What are the Non-opioid Prescriptions Doing to Consumers?

The CDC’s 2016 recommendations for opioid prescriptions prompted researchers to investigate whether prescription patterns changed since their release, and a study on their findings was published in 2022. Researchers found that patterns did in fact change significantly from 2012 to 2018. In 2012, the prevalence of opioid prescriptions was approximately equal to that of non-opioid medication prescriptions, but by 2018, there were about 50% more prescriptions for nonopioids than opioids. This suggests that many healthcare professionals have been following the CDC’s guidelines by prescribing opioids cautiously. However, the increases in non-opioid prescribing were much higher than expected, and the decreases in opioid prescribing were not completely offset by these increases.

Further research is therefore necessary to determine if the use of nonpharmacologic treatments like physical therapy also increased during this period, but these findings are good news nonetheless, as they show that opioid are not being prescribed nearly as frequently as they once were, which is saving many patients from future issues with dependence and addiction.

Before Any Drugs, You Should See One of Our Physical Therapists First

There is a place for medication. However, often medications don’t work, can be abused, or have terrible side effects.  Given that physical therapy is as effective for most muscle and joint pain diagnoses, it only makes sense that you contact us first at one of our two locations, to see if we can help…and permanently end your pain.

In Honor of National Physical Therapy Month, Learn How Physical Therapy Can Save You Time And Money While Avoiding Unnecessary Tests And Interventions

Every October, physical therapists around the country come together to celebrate National Physical Therapy Month. The purpose of this annual campaign is to highlight the many ways that physical therapists can provide numerous benefits to individuals of all ages with an individualized approach to neuro-musculoskeletal conditions & treatment. In honor of the month, we’d like to discuss a few of the key reasons why seeing a physical therapist first for numerous types of pain is likely to be the best treatment decision you can make.

Quick Access = Quick Relief

For anyone that experiences pain or gets injured, quick relief is often the number one priority. There are many treatment options available to address painful conditions, and it may be difficult to decide what’s best for you. But regardless of your diagnosis or its severity, one universal truth applies: trying physical therapy first is a smart move that will usually help you avoid other unnecessary tests, drugs, injections, and surgery in the future.

Physical therapy is not a cure-all that will immediately fix any physical problem, but it does have vast range of applications and is appropriate for most painful conditions. Every physical therapy treatment program is individually tailored with each patient’s abilities and goals in mind, and by carefully guiding patients through exercises and movement-based techniques, significant improvements are very likely to occur.

Physical Therapy vs. Surgery, Injections, and Opioids

Other popular treatments for pain include surgery, injections, and prescription medications like opioids, but research continuously shows that physical therapy is a wise option that will save patients money and time while leading to similar—if not superior—outcomes.

For example, one study found that physical therapy was just as effective as surgery for patients with various tendon disorders, while another found only minimal differences after five years between patients treated with surgery versus physical therapy for ACL tears. Physical therapy can also help patients avoid taking prescription drugs like opioids, which are a significant problem in the country today due to alarmingly high rates of addiction, overdose, and death. One study found that patients who underwent physical therapy had a lower chance of being prescribed opioids the next year, while another found that those who saw a physical therapist early were 33% less likely to use narcotics like opioids and 50% less likely to receive non-surgical invasive procedures than patients who did not.

Seeing a Physical Therapist First Saves You Money

Seeing a physical therapist early is also associated with better odds to experience a positive outcome with lower overall healthcare costs. This is exemplified in other research that found early physical therapy to be associated with an average savings of $2,172 on healthcare costs over one year compared to late physical therapy, as well as a lower risk for patients being prescribed opioids, having a spinal injection, or undergoing an imaging test.

Physical Therapy in Hospitals Associated with Higher Costs

Avoiding the hospital for elective reasons like surgery will further lower costs for patients, as receiving physical therapy in a hospital is typically lower than receiving it at a clinic. One study compared these costs, and results showed that the average prices were 41% higher for therapeutic exercises and 64% higher for manual (hands-on) therapy in a hospital than a community setting. A 15-minute session of manual therapy, for example, was about $58 in a hospital versus $35 in a clinic.

In addition, you can often see a physical therapist much sooner than some other healthcare professionals. While it could take several days, weeks, or longer to get an appointment with certain healthcare professionals, many physical therapy practices can schedule you as soon as the next day. This yields further dividends, since the sooner you see a physical therapist, the better your outcome will be.

So if you’re currently dealing with any type of painful condition, we strongly recommend seeing us before consulting with your primary care doctor. We can quickly identify the source of your problem and get you started on a tailor-made treatment program right away that factors in your needs, abilities, and goals.

Contact Our Hanford or Visalia Office for More Information  – Click Here for Details

Exercise Therapy Is A Safe Intervention With A Low Risk For Adverse Events

Physical activity and exercise are regarded as integral components of physical therapy for most musculoskeletal disorders (eg, knee osteoarthritis, shoulder, neck, back pain, ankle sprains, etc.), as well as for losing weight and for treating various other conditions, such as depression, heart disease, and high blood pressure. These interventions are generally extremely safe, with reported adverse events—or side effects—expected to be less frequent and less severe than those associated with pharmaceutical or surgical interventions.

Nonetheless, it’s important to report on the severity, type, and frequency of adverse events that do occur from exercise interventions so that patients are aware of the potential risks involved and how these risks compare with other interventions. Therefore, a powerful study called a systematic review and meta-analysis was conducted to evaluate the relative risk of serious and non-serious adverse events from exercise therapy.

Researchers analyze 180 reviews that include 778 primary studies

Before discussing the details of the study, it’s important to state some key definitions:

• Physical activity: as any bodily movement produced by skeletal muscles that results in energy expenditure
• Exercise: a subset of physical activity that is planned, structured, and repetitive, and has a final or intermediate objective of improving or maintaining physical fitness
• Exercise therapy: a regimen or plan of physical activities designed and prescribed for specific therapeutic goals
• Adverse event: an undesirable or harmful outcome that occurs during or after the use of an intervention; can be serious (ie, leads to death, hospitalization, or serious risk of health deterioration) or non-serious (all other reported events)

Using these definitions, researchers performed a search of the Cochrane Library for Cochrane systematic reviews that investigated the effectiveness of exercise therapy for any condition. Exercise therapy had to be the main intervention of the study and each exercise session had to include active exercise therapy for at least 50% of the total time. The exercise also could not be combined with any pharmacological, surgical, or electrotherapeutic intervention.

Analysis of Top Quality Research (i.e. Cochrane Reviews) Shows Exercise Therapy Continues to be a Great Choice

This led to 180 Cochrane reviews being included, and 773 primary studies were identified from these reviews, with 378 reporting serious adverse events and 375 studies reporting non-serious adverse events. The main finding from these studies was that there was no increase in the risk of a serious adverse event from exercise therapy compared to a non-exercise intervention; however, there was an increase of 19% in the risk of a non-serious adverse event. This means that for every 6 people who participated in an exercise intervention, one additional non-serious adverse event occurred in the exercise group. The most common non-serious adverse events reported were pain, fatigue, bursitis, low back pain, and edema (swelling).

NOTE: this study examined exercise therapy prescribed by a number of different healthcare providers…not just physical therapists.  Adverse events with our patients happen far less than 1 in 7 of our patients.  Nevertheless, we wrote this post to let you know that non-serious adverse events in response to exercise therapy can happen, albeit, they are very rare at our practice.

Physical Therapist Directed Exercise Therapy is the Clear Winner for Natural/Conservative Care of Most Musculoskeletal Injuries

These results show that while there was an increase in the relative risk of non-serious adverse events associated with exercise therapy (provided by anyone), it was small. Therefore, exercise therapy can be regarded as a relatively safe intervention. Thus, physical therapists and other healthcare providers that prescribe exercise therapy are appropriately including it as an essential component of treatment for patients with various conditions.

If you’re dealing with pain of any sort, Bacci & Glinn Physical Therapy can help.

Call us at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) for more information or schedule an appointment today.