Pain Management and the Opioid Crisis
Chronic pain, defined as pain that lasts longer than three months, affects approximately 50 million American adults[1] and is described in medical literature as “among the most controversial and complex”[2] medical conditions to manage. The pain can be constant and even debilitating, with causes ranging from underlying illnesses such as heart disease or cancer, old or new injuries, or the lingering effects of medical procedures. A report by the U.S. Department of Health and Human Services (HHS) states that chronic pain and its treatment “can be a lifelong challenge at the individual level and is a significant public health problem.”[3]
Unfortunately, the focus of the health care system since the mid-1990s has been on quick-fix solutions to manage pain through prescription pharmaceuticals, rather than on treating the actual source(s) of the pain. This has led to a dramatic increase in the prescription of opioids, which has in turn led to a crisis of opioid misuse and addiction.
Effects of Opioid Use
While opioids may be effective in treating pain, the solution is often short-lived and works only to treat the symptom of pain rather than the source. It can also come with many deadly side effects. In fact, deaths caused by the overdose of prescription opioids quadrupled over the past 15 years, and former CDC director Thomas Frieden notes that “we know of no other medication routinely used for a nonfatal condition that kills patients so frequently.”[4] In addition to the risk of addiction and overdose, opioids also have many side effects such as increased tolerance, increased sensitivity to pain, constipation, nausea, confusion, depression, lowered testosterone levels, among others. A small but growing percentage of those addicted to prescription opioids also transition to heroin, a drug that is cheaper and sometimes easier to procure.
Opioid dependence also takes a considerable toll not only on the user, but their finances and the mental, emotional and financial toll on the user’s families and support systems. “Inappropriate prescribing of opioid analgesics,” the HSS reported, “not only contribute to poor-quality care for people with pain, but also increase health costs.”[5] Prescription opioid misuse has significantly increased the cost of health care, substance abuse treatment, and criminal justice, while decreasing the productivity among users who do not encounter the most dire consequences of addiction.
Of course there are instances where opioids are the appropriate course of action, however, providers need to understand and convey the risks and other non-pharmacologic solutions that can treat chronic pain, such as physical therapy.
What is Physical Therapy?
Physical therapists (PTs) are licensed clinical professionals who are experts in human movement. They assess and treat people of all ages and abilities by combining their education, clinical experience, and medical research to maximize an individual’s movement and improve or maintain their functionality and quality of life. Based on their evaluation and each patient’s goals, PTs design individualized care plans, conducting interventions, reexaminations, and modifying the treatment as needed to optimize the patient’s recovery. They also work closely with other health care professionals, such as physicians, nutritionists, and other specialists to provide multidisciplinary care as needed. Through prescribed movement, patient education, and hands-on care, PTs help their patients recover as soon as possible, stay physically active, and regain their functionality and manage their pain safely.
When working with patients in pain, physical therapists will evaluate the individual not only for symptoms of pain but for the underlying causes. They assess the frequency, intensity, quality, and temporal and physical characteristics of the pain while evaluating the patient for other risk factors, such as dysfunctional movement patterns, sedentary lifestyle, psychological factors like PTSD or anxiety, and pertinent medical history that may be the cause of pain now and in the future. Physical therapy routinely addresses issues such as impaired muscle strength and endurance, musculoskeletal imbalances, decreased range of motion, decreased flexibility, postural deviations, gait abnormalities, spasticity, and a number of other factors that can cause or contribute to chronic pain. Interventions frequently consist of therapeutic exercise, massage, joint mobilization, neuromuscular re-education, application of thermal agents, aerobic conditioning, and invariably patient education.
A Multidisciplinary Approach to Manage Pain
Non-opioid options are not only safer but more effective and longer lasting in treating pain. Physical therapists, are key members of a multidisciplinary pain teams that frequently comprises of doctors, pharmacists, psychologists, vocational counselors, occupational therapists and other related health care professionals. The multidisciplinary approach to pain management has proven safer and more effective than pharmacological treatment alone and improves patient’s overall quality of life.
The CDC stated in a recent report that “non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain.”[6] In order to better treat these individuals, the healthcare system must reexamine its approach to pain and focus on identifying and treating the sources of pain while providing solutions that align best with the patient’s goals and values, ensuring that the patients and their families have access to multiple options for care. Incorporating a multidisciplinary approach will not only improve patient outcomes but also improve the trajectory of the national opioid health crisis.
LIFE CARE PLANNING FOR CHRONIC PAIN
For individuals that suffer from chronic pain, many careful balances must be considered in order to help them achieve their best quality of life. A life care plan can help strike this balance. When preparing a life care plan for an individual suffering from chronic pain the author must take special care to address the specific needs of the individual because no two patients are the same. A detailed evaluation of the client and collaboration with their their doctors and therapists is vital for an effective plan. With the multidisciplinary model in mind, the life care plan will frequently include recommendations for physician services, diagnostic testing, psychological counseling, dietary counseling, interventional pain management, pharmacology, interventions for sleep restoration, adaptive and mobility equipment, vocational counseling and always physical therapy.
Learn more about life care plans and the process of creating a life care plan by visiting these resources on our site (link to other articles), or schedule your free consultation with us today.
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[1] “Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – United States, 2016,” Centers for Disease Control and Prevention, September 14, 2018, https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm.
[2] “Opioid Abuse in Chronic Pain – Misconceptions and Mitigation Strategies,” The New England Journal of Medicine, March 31, 2016, https://www.nejm.org/doi/full/10.1056/NEJMra1507771.
[3] “National Pain Strategy Report,” National Institute of Health Interagency Pain Research Coordinating Committee, accessed January 17, 2021, https://www.iprcc.nih.gov/national-pain-strategy-overview/national-pain-strategy-report.
[4] “Reducing the Risks of Relief – The CDC Opioid-Prescribing Guideline,” The New England Journal of Medicine, April 21, 2016, https://www.nejm.org/doi/full/10.1056/NEJMp1515917.
[5] “National Pain Strategy Report,” National Institute of Health Interagency Pain Research Coordinating Committee, accessed January 17, 2021, https://www.iprcc.nih.gov/national-pain-strategy-overview/national-pain-strategy-report.
[6] “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016,” Centers for Disease Control and Prevention, accessed January 18, 2021, https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf.