Physical Therapy First to Avoid Opioids

SEEING A PHYSICAL THERAPIST FIRST FOR LOW BACK PAIN REDUCES THE CHANCES OF USING OPIOIDS

The opioid epidemic continues to ravage the U.S. In 2015, more than 12 million Americans reported long-term use or misuse of opioids, and there were over 42,000 deaths related to opioids in the following year. These statistics—which have largely been driven by an ongoing trend of over-prescribing pain medications—are just a brief glimpse into this multifaceted issue and the toll it’s been taking on the country.

Low back pain (LBP) is one of the most prevalent health conditions that American seek out medical care for, as up to 80% of the population will experience it at least once at some point in their lives. Several studies have shown that LBP is also among the most common conditions for which opioids are prescribed, and more than half of individuals who use opioid report a history of back pain.

This is all in spite of the fact that most guidelines recommend that opioids are not used for LBP unless other recommended treatments have failed and it’s likely that the expected benefits of opioids will outweigh the risks. Instead, these guidelines recommend that patients with LBP try other non-drug treatments first, which includes physical therapy, exercise, and other similar interventions.

Physical therapy is a movement-based strategy that addresses painful issues like LBP with a variety of exercises and techniques designed to alleviate symptoms and help patients move more easily. The primary advantage of physical therapy is that it identifies the root of the problem and helps patients learn to overcome it with specific movements, while pain medications like opioids are only intended to be a short-term solution that simulates pain relief. Physical therapy is also regarded as an extremely safe intervention with minimal to no risk for side effects.

Why physical therapy is recommended first, as outlined by a recent study

Patients with LBP have several options when it comes to deciding what type of medical professional to see for their condition, and it’s possible that who they see may affect the likelihood of receiving an opioid prescription in the future. With this in mind, a study was conducted to evaluate whether there is a connection between the medical professional these patients see and their eventual use of opioids. Below is a summary of the results:

  • Over five years, there were 126,504 patient visits for LBP
    • More than half of patients (53%) initially saw a primary care doctor, while only 1.6% initially saw a physical therapis
  • About 18% of patients received an opioid prescription within 3 days of the initial visit, 22% received one within 30 days, and 1.2% used them in the long term
  • Patients who saw a chiropractor, acupuncturist, or physical therapist first all had significantly decreased odds of both early and long-term opioid use compared to those who saw a primary care doctor first
    • Patients who visited a physical therapist first had a 85% decreased chance of using opioids early after their visit compared to a primary care doctor

These findings show that it really does make a difference what type of medical professional you see first for LBP, and this applies to other conditions as well. Patients in pain are therefore encouraged to see a physical therapist before anyone else in order to begin an effective treatment plan that will lead to improvements while avoiding the risk of being prescribed opioids.