The final report from a US Department Health and Human Services (HHS) inter-agency task force on pain management best practices is out, and its call for greater collaborative care and improved access to physical therapy comes through loud and clear. It’s a report that in many ways echoes APTA’s white paper on opioids and pain management published nearly 1 year ago.
The “Report on Pain Management Best Practices” changed little from its draft version released in January [Editor’s note: this PT in Motion News article covered the draft in depth]. Like its predecessor, the report identifies gaps and inconsistencies in pain management that can contribute to opioid misuse.
While the task force acknowledges that opioids may be appropriate when carefully prescribed in some instances, it also argues that other approaches—including “restorative therapies” furnished by physical therapists and other health care professionals—should be on equal footing with pharmacological alternatives, particularly when it comes to reimbursement and patient access.
Danette Lake thought surgery would relieve the pain in her knees.
The arthritis pain began as a dull ache in her early 40s, brought on largely by the pressure of unwanted weight. Lake managed to lose 200 pounds through dieting and exercise, but the pain in her knees persisted.
A sexual assault two years ago left Lake with physical and psychological trauma. She damaged her knees while fighting off her attacker, who had broken into her home. Although she managed to escape, her knees never recovered. At times, the sharp pain drove her to the emergency room. Lake’s job, which involved loading luggage onto airplanes, often left her in misery.
When a doctor said that knee replacement would reduce her arthritis pain by 75 percent, Lake was overjoyed.
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.
In my job as a physical therapist, the impact of the opioid epidemic is impossible to ignore. A large percentage of my patients are dealing with some degree of pain. For some, it is the result of a surgery, for others, a sports injury, and some have been living in chronic pain for over a decade. I understand why patients are prescribed opioids, and I don’t discount them as a valuable tool in treating acute pain. However, I believe it’s important to match the pharmaceutical intervention to the severity of the condition and provide a treatment plan that ultimately works toward little or no pharmacology whenever possible.
A recent study from Penn Medicine examined emergency room visits in the U.S. for ankle sprains — one of the most common injuries in sports for which the acute treatment is rest, ice, compression and elevation. An anti-inflammatory, such as ibuprofen, helps to reduce swelling and usually provides adequate pain relief. The researchers found on average 25 percent of these patients were prescribed an opioid in the ER. This is an example of a mismatch between injury and medical prescription. An ankle sprain will rarely necessitate an opioid prescription, and this study highlighted the over prescribing practices taking place across the nation — in some states more than others.
Tennis elbow is also known as lateral epicondylitis. It occurs when a person strains the tendons in their forearm. People can usually treat tennis elbow at home with rest and over-the-counter medication. Doing specific exercises can also help ease the pain and prevent reoccurrence.
We describe eight exercises to help strengthen muscles in the forearm and prevent tennis elbow from coming back. We also cover causes and symptoms, home treatment, prevention, and when to see a doctor.
Before trying these exercises, wait for any swelling to go down. It is also a good idea to check with a doctor or a physical or occupational therapist first.
A drug already proven safe for use in people may prevent opioid tolerance and physical dependence when used in combination with opioid-based pain medications, according to a new study in mice.
Researchers have discovered that a compound previously tested to treat osteoarthritis pain appears to block neuropathic pain and decrease signs of opioid dependence.
When drug manufacturer Eli Lilly and Co. conducted human trials of the drug to treat osteoarthritis pain, they found that the drug lacked efficacy. Researchers had not, however, tested the drug’s use in treating other kinds of pain and lessening opioid dependence.
For some patients, physical therapy can both decrease overall health care utilization and save money down the road—especially if delivered sooner rather than later. These were the takeaways from 2 articles in a May 2018 special issue on nonpharmacological management of pain published by PTJ (Physical Therapy), APTA’s scientific journal. PTJ Editor-in-Chief Alan Jette, PT, PhD, FAPTA, interviewed authors of each of the studies via podcast.
One study, coauthored by Xinliang “Albert” Liu, PhD, examined the effect of timing of physical therapy on downstream health care use and costs for patients with acute low back pain (LBP) in New York state. The patients were categorized by whether and how soon they received physical therapy after seeing a physician for LBP: at 3 days, 4–14 days, 15–28 days, 29–90 days, and no physical therapy. Patients who received physical therapy within 3 days (30%) incurred the lowest costs and utilization rates, while those who didn’t see a PT at all saw the greatest of both.
Citing a lack of evidence-based guidelines for managing acute and chronic pain in elite athletes, the International Olympic Committee (IOC) issued a consensus statement (abstract only available for free) recommending a comprehensive, multidisciplinary team approach to address “biomechanics and the kinetic chain continuum, and psychosocial and contextual domains” among elite athletes. It’s an approach that recognizes physical therapists (PTs) as “front-line clinicians who … address conceptualizations of pain and injury.”
While experts suggest nonpharmacologic interventions as first-line treatment, IOC authors acknowledge that “when an athlete has severe acute pain, relief of pain is not only humane but may be necessary to facilitate early mobilization.” Drugs, they state, should be used only as “one component” of a broader plan that could include physical therapy, psychosocial interventions, and, if necessary, surgery.
The recommendations contained in a new National Academies of Sciences, Engineering, and Medicine (National Academies) report on pain management and the opioid crisis are wide-ranging, but a few may sound familiar to physical therapists (PTs), physical therapist assistants (PTAs), and anyone familiar with APTA’s #ChoosePT campaign—namely, the need to support nonpharmacologic approaches to pain treatment through better reimbursement models, and the necessity of continued efforts to educate the public on effective alternatives to opioids.
The positions on reimbursement and public education were among 21 recommendations included in the National Academies’ report titled “Pain Management and the Opioid Epidemic,” a comprehensive document that examines the opioid crisis from multiple perspectives. The overarching theme of the report: if America is serious about solving the opioid crisis, it’s going to require work and change at nearly every level of health care, public policy, and even clinical education.
There was plenty to blame: the car wreck that broke his back. The job pouring concrete that shattered his spine a second time. The way he tore up his insides with cigarettes, booze, cocaine, and opioids.
It all amounted to this: Carl White was in pain. All the time. And nothing helped — not the multiple surgeries, nor the self-medication, not the wife and daughter who supported him and relied on him.
Then White enrolled in a pain management clinic that taught him some of his physical torment was in his head — and he could train his brain to control it. It’s a philosophy that dates back decades, to the 1970s or even earlier. It fell out of vogue when new generations of potent pain pills came on the market; they were cheaper, worked faster, felt more modern.