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Early Physical Therapy May Reduce Opioid Use For Severe Pain

Amid national concern about the overuse of prescription opioids, a new large-scale study provides strong evidence that physical therapy can be a useful, nonpharmacologic approach for managing severe musculoskeletal pain.

Duke and Stanford researchers analyzed the data of nearly 89,000 pain patients and found that those who were given physical therapy soon after being diagnosed with pain in the shoulder, neck, lower back or knee were approximately 7 to 16 percent less likely to use opioids in the subsequent months.

For those who did use opioids for pain, early physical therapy was tied to a 5 to 10 percent reduction in how much of the drug they used.

“We asked ourselves, ‘How can we address the pain that people are having, while not increasing their risk of needing opioids?'” said lead author Eric Sun, M.D., Ph.D., assistant professor of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine.

“And what our study found was that if you can get these patients on physical therapy reasonably quickly, that reduces the probability that they’ll be using opioids in the longer term.”

For the study, Sun and senior author Steven George, Ph.D., professor of orthopaedic surgery at Duke University School of Medicine, analyzed private health insurance claims for care and prescriptions between 2007 and 2015.

They reviewed claims for outpatient and emergency room visits for the earliest instance of a diagnosis of shoulder, neck, knee or low back pain among privately insured, nonelderly adult patients.

The study screened out patients who had recently taken opioids by including only those who hadn’t filled an opioid prescription within the previous year. They also screened out patients with less serious pain by including only those who had visited a doctor for their condition within 30 days of their initial diagnosis and were given at least one opioid prescription within 90 days. The final sample included 88,985 patients.

After adjusting for co-morbidities, such as diabetes and hypertension, the research team found that the odds of patients filling an opioid prescription three months to a year after their initial pain diagnosis were lower if they had been given at least one physical therapy session within 90 days of their diagnosis.

The odds were reduced by 16 percent for patients with knee pain, 15 percent for shoulder pain, 8 percent for neck pain and 7 percent for lower back pain.

“This isn’t a world where there are magic bullets,” Sun said. “But many guidelines suggest that physical therapy is an important component of pain management, and there is little downside to trying it.”

The researchers also looked at whether early physical therapy was associated with a decreased need for opioids in the long term among patients who filled prescriptions.

They found, after adjusting for confounding factors, that patients who had received early physical therapy used 10.3 percent less opioid medication for knee pain; 9.7 percent less for shoulder pain; and 5.1 percent less for back pain in the period three months to a year after their diagnosis. There was no significant reduction for neck pain.

In addition, physical therapy within three months of diagnosis was tied to a decreased likelihood that patients with two of the conditions would chronically use opioids in the long term.

After early physical therapy, patients with knee pain were 66 percent less likely in the period three months to a year after their diagnosis to either fill 10 or more prescriptions or acquire a supply of opioid medication for 120 days or more.

Those with low back pain were 34 percent less likely to be chronic users if they had early physical therapy. There was no link between physical therapy and chronic opioid use among patients with shoulder or neck pain, however.

“The general consensus is that for musculoskeletal pain, opioids generally aren’t a long-term solution,” Sun said. “Aside from all the other side effects, even if the medication is doing well for you, it will have less and less effect over time as your body builds up a tolerance.”

The findings are published in the journal JAMA Network Open.

Source: Stanford Medicine

 



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