Chronic pain affects nearly one-third of the American population, according to a 2011 report by the Institute of Medicine on advancing pain research care and education. Over the past several years, the use of prescription drugs to manage pain has increased exponentially. These drugs have not only proven to be largely ineffective, but also expose millions to highly addictive medications which often lead to substance use disorders and death.
Increasingly, non-pharmaceutical approaches, including physical therapy, are being recommended as a “first-line treatment” for pain management.
The Centers for Disease Control and Prevention (CDC) released a set of guidelines in March 2016 with the intent to limit opioid prescriptions to cancer treatments, palliative care, end-of-life care, and certain emergency situations. For any other instance of pain management, the CDC recommends “non-opioid approaches,” like physical therapy.
Even when opioids are prescribed, the CDC recommends that patients receive the lowest effective dosage and that it be combined with physical therapy or another “non-opioid” treatment.
“Physical therapists and occupational therapists can play a big role in pain management,” says Gina Ruppert, PT, CLT, a physical therapist at Chester County Hospital. “We have a lot of tools in our arsenal that don’t involve medications. And although PT is often thought of as exercise or massage, it’s more accurate to see it as an evolving, holistic approach.”
Incorporating alternative approaches to help combat the overuse of prescription medications is not new to the health system. Experts across specialties including Emergency Medicine, Behavioral Economics, Orthopaedics, Plastic Surgery, Obstetrics & Gynecology, and Psychiatry have been working for years to reduce the number and doses of opioid prescriptions given to patients through the development of new procedures and protocols. And, two years ago, Penn Medicine created the Health System-wide opioid task force, cementing itself as a leader in the fight against opioid addiction.
Jill Townsend, PT, CHT, lead hand therapist at Chester County Hospital, says the treatment physical therapists provide is a collaborative effort with their patients and health care providers.
“We identify what’s causing their pain first and then work to help them understand their diagnosis and develop tools to help manage their pain,” she says. “In the vast majority of cases, we’re able to resolve the problem. In chronic cases, patients are given the tools to manage and control their discomfort.”
That work is not entirely physical. Some of the effort involves helping patients to identify potential emotional or environmental triggers for their pain. Stress, for example, can increase physical discomfort, so Townsend and Ruppert help patients practice stress management principles through breathing, visualization, and relaxation techniques.
The physical aspect of pain can also be addressed through a variety of approaches that can improve circulation, decrease swelling, reduce muscle spasm, and treat pain. These include heat, cold, ultrasound and electric stimulation. Manual therapy (massage, mobilization and manipulation of joints and soft tissue) has also been proven effective in using the body’s own ability to control pain.
Patients are given an individualized exercise program which helps to address their specific strength and flexibility deficits. Aerobic exercise, specifically, is another way of using the body’s own defense against symptoms. Therapists also do ergonomic training, sleep education, and movement analysis, where the patient is taught how to move, sit, and stand more efficiently.
“Although we have guidelines and general indications, everything is based on clinical reasoning, which is understanding the science of the patient’s pathology and implementing an individualized plan,” Townsend says. In other words, every patient’s treatment is tailored to their particular needs and ability.” An integral component of that process is a constant, open dialogue between the therapist and patient.
“Often through the course of treatment, their pain will change. It could even happen on a day-to-day basis,” Ruppert says.
The challenge, Townsend says, is to have patients respect their pain without over-analyzing it. “Focusing too much on pain can increase pain.”
As the role of the physical therapist continues to evolve and compliment current care protocols, it will allow patients to benefit from more holistic and well-rounded therapies for a variety of conditions.