New Research: Prescriptions for Narcotics Are Surging for Knee Pain

Although physical therapy and lifestyle changes have been shown to bring significant improvements to those with knee osteoarthritis, new research suggests U.S. physicians may be leaning toward pain medications instead.

Published in Arthritis Care & Research, the study looks at 2,297 physician visits for the condition, data that’s kept in a national database. Researchers found that PT and lifestyle suggestions—like losing weight, quitting smoking, eating healthier foods, and getting more exercise—declined from 2007 to 2015, while prescriptions for nonsteroidal anti-inflammatory drugs, narcotics, and opioids increased.

In fact, during study period, lifestyle recommendations and referrals for physical therapists were reduced nearly by half, while prescriptions for narcotic pain relievers nearly tripled.

Full story at Runner’s World

Most kids can manage pain after surgery without opioids

About one in five kids are prescribed opioids after common pediatric surgeries, but a new study suggests they may do just as well with alternative pain relievers like acetaminophen or ibuprofen.

From 1999 to 2016, opioid-related overdoses rose by 250% among children and teens in the U.S., prompting widespread efforts to curb use of these addictive narcotic painkillers. Even though acute pain after surgery is the most common reason opioids are prescribed for kids, it’s not been clear how well this type of pain relief stacks up against other options, researchers note in JAMA Surgery.

For the current study, researchers asked caregivers of 404 kids under age 18 to log how often children took prescribed painkillers and whether the caregivers felt their pain was well controlled.

Full story at Reuters

4 Videos (and a Podcast) to Get You Ready for Pain Awareness Month

September is National Pain Awareness Month—a perfect opportunity to spread the word about the important role physical therapists (PTs) and physical therapist assistants (PTAs) play in the management of pain, and the unique knowledge they bring to the table.

Need a reminder of why patient access to physical therapy for pain is so crucial, or inspiration to get you thinking about your own activities during National Pain Awareness Month? Here are some standout videos—and a podcast—that do just that. All but 1 were produced by APTA.

A Journey Out of Pain and Addiction, and a PT’s Crucial Role
What it’s about: In his keynote address for the 2019 APTA NEXT Conference and Exhibition, US Army Master Sergeant (Retired) Justin Minyard recounted the injuries he received during rescue attempts first at the Pentagon during the 9-11 attacks and then while on a mission in Afghanistan. But the heart of Minyard’s story is about what happened afterward: the multiple fusion and other surgeries, the intense pain, his slide into addiction, and his eventual freedom from opioids. He readily acknowledges that his recovery was thanks in large part to the work of an interprofessional team that included a dedicated physical therapist.

Full story at APTA

‘Where Might We Be Now?’ APTA Congressional Briefing Makes a Personal Case for Pain Treatment Alternatives

The plan was set: on May 21, APTA would hold a congressional briefing on the importance of increasing patient access to nonpharmacological approaches to pain treatment. The event would be highlighted by the story of Cindy Whyde and her son Elliott, who became addicted to prescription opioids, and eventually heroin, after receiving an opioid prescription to treat a high school football injury 9 years ago. Elliott’s road to recovery has not been easy.

But the briefing didn’t go as planned. Days before the Whydes were to travel to Washington, DC, Elliott relapsed into addiction and disappeared. Cindy came to the event alone, determined to do whatever she could to effect change. At the time of the event Elliott had been missing for 3 days.

“That is one of the worst fears any parent should have to go through, not knowing where their child is and what’s going on with them,” Whyde said.

Full story at APTA

Early physical therapy associated with reduction in opioid use

Patients who underwent physical therapy soon after being diagnosed with pain in the shoulder, neck, low back or knee were approximately 7 to 16 percent less likely to use opioids in the subsequent months, according to a new study by researchers at the Stanford University School of Medicine and the Duke University School of Medicine.

For patients with shoulder, back or knee pain who did use opioids, early physical therapy was associated with a 5 to 10 percent reduction in how much of the drug they used, the study found.

Amid national concern about the overuse of opioids and encouragement from the Centers for Disease Control and Prevention and other groups to deploy alternatives when possible, the findings provide evidence that physical therapy can be a useful, nonpharmacologic approach for managing severe musculoskeletal pain.

Full story at news-medical.net

Surprisingly, opioids may increase risk of chronic pain

After surgery, opioids — such as morphine — are routinely used to manage pain. However, according to a new study, the drugs could actually raise the likelihood of experiencing chronic pain.

Opioids are big news. The “opioid epidemic” in the United States is destroying lives from coast to coast.

More than 100 people die from opioid-related overdoses each and every day in the U.S.

Despite the horrors of addiction, one aspect of opioid use that is rarely questioned is just how effective they are at fulfilling their primary function: to quell pain.

Full story at Medical News Today

JAMA Study: Opioids No Better Than Nonopioids in Improving Pain-Related Function, Intensity for Chronic Back Pain, Hip/Knee OA

APTA’s #ChoosePT opioid awareness campaign makes the case that opioids simply “mask” pain—but a new study in JAMA has concluded that the drugs probably don’t even do that much, at least not any more effectively than nonopioid medications. The research, which focused on individuals with chronic back pain or hip or knee osteoarthritis (OA) pain, led authors to an unequivocal conclusion: there’s no support for opioid therapy for moderate-to-severe cases of those types of pain.

The published findings are based on a study of 240 randomized patients in the Minneapolis, Minnesota, Veterans Affairs (VA) health care system who reported chronic back pain or knee or hip OA pain, defined as daily moderate-to-severe pain for 6 months or more with no relief provided by analgesic use. Participants were divided into 2 groups: 1 that received an opioid regimen, and a second group that received nonopioid drugs.

To more closely resemble real-world treatment, researchers used a “treat-to-target” approach that stepped up the drugs as needed for participants to reach identified goals. The opioid regimen began with immediate-release morphine, hydrocodone/acetaminophen, and oxycodone, but the regimen could advance to sustained-action morphine and oxycodone, and on to transdermal fentanyl. The nonopioid approach began with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS), but it could move on to topical analgesics and finally to drugs requiring prior authorization (such as pregabalin and duloxetine), including tramadol. All participants also were permitted to pursue nondrug treatment during the study, but researchers did not evaluate data related to those treatments.

Full story at APTA

An opioid remedy that works: Treat pain and addiction at the same time

Seven years ago, Robert Kerley, who makes his living as a truck driver, was loading drywall when a gust of wind knocked him off the trailer. Kerley fell 14 feet and hurt his back.

For pain, a series of doctors prescribed him a variety of opioids: Vicodin, Percocet and OxyContin.

In less than a year, the 45-year-old from Federal Heights, Colo., said he was hooked. “I spent most of my time high, laying on the couch, not doing nothing, falling asleep everywhere,” he said.

Full story at Science Daily

Holistic Therapy Programs May Help Pain Sufferers Ditch Opioids

Each year, more than 300 patients with chronic pain take part in a three-week program at the Pain Rehabilitation Center at Mayo Clinic in Rochester, Minn. Their complaints range widely, from specific problems such as intractable lower-back pain to systemic issues such as fibromyalgia. By the time patients enroll, many have tried just about everything to get their chronic pain under control. Half are taking opioids.

But in this 40-year-old program, they can’t stay on them. Participants must agree to taper off pain medications during their time at Mayo.

Still, more than 80 percent of the patients who enroll remain through the entire program, says Wesley Gilliam, the center’s clinical director. And many previous opioid users who finish the treatment report six months later that they have been able to stay off those drugs. Just as important, he adds, they have learned strategies to deal with their pain.

Full story at NPR

Study: LBP Patients With Comorbidities at Higher Risk for ‘Guideline Discordant’ Care

Authors of a new study have found that for patients with low back pain (LBP), the presence of comorbidities such as diabetes, mental health issues, and hypertension raises the risk that they’ll receive LBP care that uses more resources and veers off-course from LBP guidelines—including more prescriptions for opioids.

The study, published in the Journal of Evaluation in Clinical Practice, analyzes commercial insurance claims data from 2007 to 2011 involving 513,980 adults with new visits for back pain. Researchers tracked LBP care-related claims for 3 years after the initial visit as well as procedure use and treatment patterns for the first 42 days after the visit, and matched these data with patients identified as having 0, 1, or 2 or more comorbidities based on ICD-9 codes. APTA member Sean Rundell, PT, DPT, PhD, was lead author of the study.

Full story of LBP patients and guideline discordant care at APTA