Physical Therapy vs. Opioids:
When to Choose Physical Therapy for Pain Management
By Dr. Norene Christensen, PT, DSc, OCS
Chronic pain is an all-too-common issue affecting millions of Americans each year. An estimated 116 million people in the U.S. suffer from chronic pain annually. As a physical therapist, I frequently encounter patients who have been prescribed long-term opioids to manage their pain. Thankfully, we are seeing a shift away from this practice, but change is not happening quickly enough.
For years, drug companies assured physicians that opioids were a safe and non-addictive option for chronic pain relief. Unfortunately, that wasn’t true, and now, we face an opioid epidemic. The U.S. leads the world in opioid usage, and this has contributed to a growing medical crisis.
In response, the CDC released updated guidelines in 2016 to encourage more cautious opioid prescriptions. While opioids are still appropriate in specific situations, such as cancer treatment, palliative care, and acute post-surgical pain, they should never be the go-to solution for long-term musculoskeletal or nerve pain. If your physician is hesitant to refill your opioid prescription, it’s because they’re trying to protect you from the harmful effects of long-term opioid use.
The Risks of Long-Term Opioid Use
Opioids may offer short-term relief, but the risks of prolonged use far outweigh the benefits, especially for managing chronic pain. Let’s take a closer look at some of the dangers associated with long-term opioid use:
- Common Side Effects: These include constipation, drowsiness, depression, and nausea.
- Hyperalgesia: Over time, opioids can trick your brain into thinking your pain is getting worse. This phenomenon, known as opioid-induced hyperalgesia, occurs because your body builds up a tolerance to the medication, and your brain starts to perceive the pain as more intense than it is. The result? You feel like you need a higher dosage when, in fact, the opioids are making the pain worse.
- Respiratory Risks: Long-term opioid use can slow your breathing dangerously during sleep. High doses of opioids suppress signals in the central nervous system, which can affect your body’s ability to regulate breathing. This is one reason opioid overdose deaths have skyrocketed, with fatal overdose rates increasing from 8,048 deaths per year in 1999 to 47,600 deaths per year in 2017.
- Physical Dependence: When you try to reduce your opioid use, your body may respond by worsening the pain. This is another form of opioid-induced hyperalgesia, making the process of tapering off the medication difficult and painful.
These risks are why it’s so important to work closely with your physician, physical therapist, and possibly a mental health professional if you’re trying to reduce your opioid intake. It can be a confusing and difficult process, but with the right support, it is possible to manage your pain without opioids.
When to Choose Physical Therapy Over Opioids
For many chronic pain sufferers, physical therapy offers a safer and more effective alternative to opioids. The CDC recommends non-opioid approaches, including physical therapy, in the following situations:
- When the risks of opioid use outweigh the rewards: If you want more than temporary relief, physical therapy offers a path to long-term recovery by addressing the root causes of your pain.
- When pain or functional problems are related to conditions like low back pain, hip or knee osteoarthritis, or fibromyalgia: Physical therapy uses movement and exercise to reduce pain and improve mobility.
- When opioids have already been prescribed: Even if opioids are prescribed for acute pain, the CDC recommends combining them with non-opioid therapies, such as physical therapy, to minimize reliance on medication.
- When pain lasts longer than 90 days: At this point, the pain is considered chronic, and the risks of continued opioid use increase significantly. Physical therapy is often a better long-term solution for chronic pain management.
How Can Physical Therapy Help You?
At Four Pines Physical Therapy, we specialize in treating chronic pain through movement and education. Our approach is patient-centered, meaning we tailor treatment plans to your specific needs and goals. Here’s how we can help:
- Listening to Your Story: We take the time to understand your pain, your challenges, and your journey. Every patient’s experience is unique, and we want to hear your story.
- A Comprehensive Evaluation: We’ll assess your movement, strength, flexibility, and tolerance for physical activity to create a personalized treatment plan.
- Education on the Neuroscience of Pain: We’ll teach you how your brain and body interact with pain, explaining the effects of opioids, the fear-avoidance cycle, and more. Understanding the brain’s role in chronic pain is a powerful first step toward recovery.
- Personalized Treatment Plans: We carefully design programs that incorporate movement, aerobic activity, mindfulness, and self-care techniques to help you regain your independence and improve your quality of life.
We also encourage you to check out Professor Lorimer Moseley’s Pain Revolution talk, where he discusses how pain can be managed through brain-body techniques. Click Here to watch the video.
Ready to Take the First Step Toward Pain-Free Living?
In Wyoming, you don’t need a physician’s prescription to start physical therapy (unless covered by VA, Medicare, Medicaid, or Worker’s Compensation). We’d love to work with your physician to provide the best care possible. If you’re unsure whether physical therapy is right for you, we offer a free 30-minute consultation—no commitment necessary.
Contact Four Pines Physical Therapy today to learn more about how we can help you manage your pain and take control of your life, without relying on opioids.
Are you ready to regain control of your health and reduce your reliance on medication? Let’s get started on the road to recovery—together.
