According to the International Association for the Study of Pain, pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” This means that pain is an experience that encompasses so much more than the physical aspect typically associated with it.1
Pain can affect how we sleep, work, focus and manage our relationships on a daily basis. It affects our stress levels and impacts how we manage anxiety. Whether we are aware of it or not, pain changes how our brain processes information and thus, can affect every aspect of our life.
Given that the prevalence of chronic pain in U.S. adults is estimated to be between 30 and 43 percent, people all over the country are desperate to find a solution to what many are calling a pain epidemic.2,3 Utilization of imaging and opioids when it comes to the management of a patient with a musculoskeletal injury varies depending on the physician’s knowledge base, comfort level and other demographic variables.16,17 But given the recent increase in opioid overdose deaths and rise of chronic pain, advanced imaging and opioid prescriptions for non-cancer pain may be doing more harm than good in the long run. It’s estimated that primary care physicians write approximately 15.3 million opioid prescriptions per year, followed closely by internal medicine physicians, nurse practitioners and physician assistants respectively.4 While intended to reduce pain and promote function, long term use of opioid medication is not only highly addictive, but can also induce the opposite effect – increasing a patient’s overall sensitivity to pain.15
Astoundingly, current research indicates that a patient given a one day opioid prescription has a 6 percent chance of being addicted a year later.5 This has subsequently contributed to a 200 percent increase in opioid-related overdose deaths since 2000.6,7 Additionally, if we look at the total number of overdose deaths per year, 61 percent of those are attributed to opioid use.8 In 2017, the U.S. Department of Health and Human Services declared this battle with opioid use a “public health emergency” and is forcing our medical community to utilize safer and more effective ways to manage pain.9
As pain and movement specialists, physical therapists are determined to help patients find answers to this widespread and complex problem. Luckily, direct access legislation makes it easier for patients to directly access their physical therapist without a physician’s prescription in many states. Not only does this make it easier for patients to avoid the wait times often associated with seeing a physician, but it can also help patients save money. Considering that the annual cost of pain (to society) now exceeds that of heart disease, cancer and diabetes combined, it’s imperative that we better manage this pain epidemic on all levels.3
In order to do this, physical therapy (PT) should be utilized as the very FIRST line of defense when dealing with a bout of musculoskeletal pain. Your physical therapist is specialized in recognizing movement dysfunction that can result in muscle, joint and nerve changes. Many of these issues can be remedied by education and instruction in physical therapy without the use of opioids or imaging. In a research article that investigated the utilization of a MRI vs PT as the first line of defense in those with low back pain, patients that received an MRI before PT were six times as likely to undergo surgery, five times more likely to receive an injection and four times more likely to have an ER visit. This results in an estimated $4,793 more in healthcare costs for those patients who receive an MRI prior to seeing a physical therapist.10
As pain specialists, your physical therapist is trained to utilize conservative treatment options like exercise, manual therapy and various alternative therapies to help manage your discomfort and dysfunction. Research has found that being seen by a physical therapist in the first 14 days of an episode of pain leads to decreased physicians visits, advanced imaging, surgery and opioid use compared to those who see PT at a later point in time.11,12,13
Despite the robust amount of research that supports the importance of seeing a physical therapist first and foremost for pain, currently only 7 percent of patients with low back pain receive PT in the first 90 days of an episode.14 This suggests that physical therapy is being underutilized within the medical community. As physical therapists, our level of education (Doctorate) and expertise in pain control make us the most cost effective and efficient front line providers when it comes to managing this pain epidemic. It’s essential that you advocate for yourselves as patients- take control of your pain today by seeing a physical therapist. We will help empower you with conservative, cost effective treatment options so you can move forward with your life and leave the pain behind.
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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
1. “IASP Terminology.” IASP, www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698.
2. Johannes, CB et al. The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain.2010 Nov;11(11):1230-9. doi: 10.1016/j.jpain.2010.07.002. Epub 2010 Aug 25.
3. IOM2011. Relieving pain in America: A blueprint for transforming prevention, care, education and research. Institute of Medicine (US) Committee on Advancing Pain Research, Care and Education.
4. Chen, JH et al. Distribution of Opioids by Different Types of Medicare Prescribers. JAMA Internal Med. 2016;176(2):259-261.
5. Shah, A et al. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use-United States, 2006-2015.Morbidity and Mortality Weekly Report. 2017. 66(10):265-269.
6. Stevens, JP et al. The Critial care crisis of opioid overdoses in the United States. Annals of the American Thoracic Society, 14(12), 1803-1809.
7. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths – united states, 2000-2014. MMWR Morb Mortal Wkly Rep 2016;64(50- 51):1378-1382.
8. “Increases in Drug and Opioid-Involved Overdose Deaths – United States, 2010–2015 | MMWR.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm.
9. Public Affairs. “What Is the U.S. Opioid Epidemic?” HHS.gov, Https://Plus.google.com/+HHS, www.hhs.gov/opioids/about-the-epidemic/index.html.
10. Fritz J, Brennan G, Hunter S. Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: Association with future health care utilization and charges. Health Research and Educational Trust. 50.6 (December 2015)
11. Fritz JFPP, Childs JD, Wainner RS, Flynn TW. Primary Care Referral of Patients With Low Back Pain to Physical Therapy. Spine. 2012;37(25):2114-2121.
12. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018
13. Childs JD, Fritz JFPP, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015;15(1):986–11.
14. Fritz JFPP, Childs JD, Wainner RS, Flynn TW. Primary Care Referral of Patients With Low Back Pain to Physical Therapy. Spine. 2012;37(25):2114-2121.
15. Hay, J. L., White, J. M., Bochner, F., Somogyi, A. A., Semple, T. J., & Rounsefell, B. (2009). Hyperalgesia in Opioid-Managed Chronic Pain and Opioid-Dependent Patients. The Journal of Pain, 10(3), 316–322.
16. Garry, Joseph P. “Musculoskeletal Medicine in the USA: Education and Training of Family Physicians.” Quality in Primary Care, IMedPub, 30 Nov. -1, primarycare.imedpub.com/musculoskeletal-medicine-in-the-usa-education-and-training-of-family-physicians.php?aid=2376.
17. Lynch, Joseph R, et al. “Important Demographic Variables Impact the Musculoskeletal Knowledge and Confidence of Academic Primary Care Physicians.” The Journal of Bone and Joint Surgery, 2006.