physical therapy versus medication

A physical therapist outlines the right and wrong ways to deal with pain.

Written by Preston Ward,PT,DPT

As a Doctor of Physical Therapy, I get asked all the time about pain. It’s a common reason for someone to go to physical therapy. Physical therapists are “movement experts,” and guided movement is often the better route for relieving pain, compared to medication.

Recently there has been an exhaustive list of news articles relating to the relatively new epidemic of opioid abuse. Overdose deaths from prescription pain relievers like oxycodone, hydrocodone, codeine, morphine, fentanyl and others quadrupled in the 2000s. In 2014, there were 18,893 deaths related to overdose of these prescription pain relievers. Sales of these drugs have skyrocketed over the last 15 years.

Here’s another alarming statistic: from 2000 to 2014 nearly half a million people died from drug overdoses. So how does all this relate to physical therapy? All these prescriptions certainly help with pain and have their place in pain management. However, they might not be the safest or most effective for dealing with long lasting pain.

There is a better strategy to managing your pain; it is safer with comparable results. Movement! Particularly for lower back pain, movement is better at managing pain than opioids, and movement is what physical therapy is all about.

The CDC came out with guidelines for prescribing opioids for chronic pain this year. It states “non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain.” Furthermore, these guidelines state that even if opioids are prescribed physical therapy or “non-pharmacologic therapy” should be used in conjunction.

Today we live by evidenced based medicine, and everyone has the resources at their fingertips to make an informed decision. If you have chronic pain, the research points to physical therapy, not drugs. It not only is safer than taking prescription opioids, given that 1 in 4 people will struggle with addiction which can lead to death, but there is high quality evidence supporting physical therapy intervention to ameliorate chronic pain. These studies have been demonstrated on large groups of people suffering from arthritis, low back pain, fibromyalgia and a myriad of other conditions.

You may ask, “what is my physical therapist going to do for my chronic pain?” Let’s take for example low back pain. Nearly two thirds of individuals will experience low back pain in their life with 30 percent turning into chronic pain. Your physical therapist will begin by questioning you about your current state and medical history. They will then carry out an extensive review to rule out or in the mechanism of your pain. Next they will educate you on their findings, the science behind pain and give you an individualized plan to get you to manage your pain. This will include goal setting, regular exercise, and exposure to the movements that initiated your pain. Overall they will get you a personalized plan to get you moving to achieve your goals, to improve your function and ultimately help you re-take control over your health. They will get you in charge.

With guided movement, physical therapy seeks to resolve the cause of the pain, rather than mask it, as medication does.

National movements are battling the opioid epidemic. The American Physical Therapy Association (APTA) has launched a national campaign, and President Obama has proposed $1.1 billion in new funding to thwart this grievous epidemic. If you are suffering from chronic pain, I encourage you to choose PT first.

Sources: American Society of Addiction Medicine, CDC, National Institute of Drug Abuse, APTA, Louw et al, Moseley et al, Delitto et al

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