ra-opioid Physical Therapy vs Opioids: Can PT Help Alleviate the Opioid Epidemic?

On February 9, 2018, Congress passed a budget deal that included a provision to repeal the Medicare Therapy Cap, culminating a 20-year advocacy campaign to eliminate a policy that limited Medicare beneficiary access to physical, occupational and speech therapy services.

The repeal of the Medicare Therapy Cap gives beneficiaries improved access to physical therapy services. This comes as hopeful news to those struggling with chronic, non-cancer pain as physical therapy has been shown as an effective and safe alternative to opioids.

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Under the cap, beneficiaries were not allowed to surpass $2010 of combined physical therapy and speech therapy services and $2010 of occupational therapy per year. Under the new budget law, patients can now receive continued therapy past this amount if medically necessary, improving access to patients with chronic non-cancer pain. Treatments provided by physical therapists may decrease one’s reliance on opioids or prevent the need for opioid use when treating chronic non-cancer pain, leading to safer self-management and potential alleviation of the opioid epidemic.

History Behind Opioids as a Standard Treatment for Pain

In 1980, the New England Journal of Medicine published a letter to the editor stating that addiction to narcotics was rare in a large population of hospitalized medical patients. The authors had examined data from almost 40,000 patients and noted a very low incidence of opioid addiction. Since its publication, this letter has been used by various sources to justify the use of opioids to treat pain and inspired a movement in medicine recognizing pain as a vital sign. A recent study indicated that 608 references to this letter were inaccurately cited as evidence that “addiction was rare with long-term opioid therapy.” The authors of the study noted that this citation pattern was a contributing factor to the opioid epidemic in the U.S, leading to overuse of these drugs for chronic non-cancer pain.

Current Costs of the Opioid Epidemic

A recent analysis estimates that the opioid crisis has cost the U.S. economy more than $1 trillion over the past 16 years. If the epidemic is not curbed, the economic impact could further increase by another $500 billion by the year 2020. Last year, opioid-related overdose deaths exceeded 62,500, with the average age of those dying from overdose being 41 years. However, more young people are falling victim to narcotic overdose as they transition from prescription opioid use to heroin and fentanyl. Additionally, healthcare expenses attributed to opioid overdoses have topped over $215 billion since 2001, largely due to visits to the emergency room, ambulance use, and distribution of naloxone (the reversal agent for opioid overdose).

#ChoosePT as a Safe Alternative to Opioid Prescription

In response to the growing opioid epidemic, the Centers for Disease Control and Prevention (CDC) released opioid prescription guidelines for primary care providers who may prescribe opioids for chronic non-cancer pain. These guidelines recognize that properly-dosed opioid medications may be appropriate in certain situations including cancer treatment, palliative care, and some acute care situations. For other types of chronic non-cancer pain, including low back pain, osteoarthritis of the knee and hip and fibromyalgia, the CDC recommends non-opioid management of pain, including physical therapy.

The main reason for the CDC recommendation against opioid therapy for chronic non-cancer pain is that the benefits just do not outweigh the risks of long-term use. Continued use of opioids for treatment of chronic non-cancer pain leads to increased tolerance to the medication, requiring an increased dose to offset pain symptoms. The main risks of long-term use are addiction and overdose. Short-term use of opioids has been shown to have moderate effectiveness in treating chronic non-cancer pain. However, while opioids may alleviate symptoms in the short-term, they do not provide a long-term solution for someone suffering from this type of pain.

Physical Therapy vs Opioids

Currently, it is estimated that 116 million Americans live with chronic pain, which can severely limit a person’s quality of life and may interfere with the ability to perform daily activities and hobbies. Exercise therapy prescribed by physical therapists has been shown to reduce pain and improve function in people with chronic low back pain, fibromyalgia and osteoarthritis of the knee and hip. The American College of Rheumatology also strongly recommends aerobic, aquatic, and resistance exercises to treat pain in people with osteoarthritis of the hip or knee.

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Physical therapists help people with chronic pain do the things they love with less suffering. We utilize movement and exercise as interventions and teach patients how to make everyday tasks and recreational activities less painful. Additionally, physical therapists educate patients on pain science and teach them how to better cope with their condition. Physical therapy offers a way to meaningfully address chronic pain in a way that opioid pain medication does not. There is a very little risk of harm when prescribing exercise or movement interventions.

The repeal of the Medicare Therapy Cap was definitely a win for patients. It may also be a victory for policymakers pledging to address the opioid epidemic problem. Our advocacy efforts cannot cease. We need to continue to educate policymakers and the public about how physical therapy can alleviate the opioid epidemic. Interventions such as exercise therapy have been shown to be effective in reducing chronic non-cancer pain. We can empower patients to achieve what they may once have thought impossible.