CDC recommends PT over opioids

The Centers for Disease Control and Prevention, concerned that sales of prescription opioids have quadrupled in the United States even though there has not been an overall change in the amount of pain that Americans report, this month released guidelines for prescribing the narcotic pain medication.

Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and other areas of the body. They reduce the sending of pain messages to the brain and reduce feelings of pain. They are used to treat moderate to severe pain that may not respond well to other pain medications.

Some types of opioid drugs include:

  •  codeine (only available in generic form)
  •  fentanyl (Actiq, Duragesic, Fentora)
  •  hydrocodone (Hysingla ER, Zohydro ER)
  •  hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
  •  hydromorphone (Dilaudid, Exalgo)
  •  meperidine (Demerol)
  •  methadone (Dolophine, Methadose)
  •  morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)
  •  oxycodone (OxyContin, Oxecta, Roxicodone)
  •  oxycodone and acetaminophen (Percocet, Endocet, Roxicet)

The CDC guidelines, available here in their entirety, recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But nonopioid approaches, including physical therapy, are recommended for other pain management, the government agency advises. Below are some hints to help the patient and provider know when to choose physical therapy over opioids.

The CDC says patients and providers should choose physical therapy when:

  • Patients are concerned about the risks of opioid use. "Given the substantial evidence gaps on opioids, uncertain benefits of long-term use, and potential for serious harms, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions," the CDC states. Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids. The CDC guidelines note that even in cases when evidence on the long-term benefits of nonopioid therapies is limited, "risks are much lower" with nonopioid treatment plans.
  • Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia. The CDC cited high-quality evidence supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
  • Opioids are prescribed for pain. Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with nonopioid therapies, such as physical therapy.
  • Pain lasts 90 days. At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are preferred for chronic pain and that clinicians should consider opioid therapy "only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."

It just makes good sense to consult with a physician and a physical therapist to discuss options for nonopioid treatment!

We at Blue Sky Therapy are ready to assist your therapy – we’re the experts!

Blue Sky Therapy has a continued commitment to patient-driven quality, excellence, integrity and innovation in everything that we do. That’s why we are scrupulous about planning the treatment of each and every client, and carefully documenting the outcome!

This information is not intended to replace the advice of a doctor. Blue Sky disclaims any liability for the decisions you make based on this information.

Related Resources:

o Health Center on Opioid Use for Pain Management

o Using Opioids for More Than 30 Days Could Increase Depression Risk

o Widespread Pain is Creating Widespread Prescription Drug Use

o Health Center on Pain

o The American Physical Therapy Association