Early physical therapy can reduce risk, amount or long-term opioid use

05-09-2019
According to a new study by researchers from Stanford University School of Medicine and Duke University School of Medicine, patients who had undergone physiotherapy shortly after the diagnosis of shoulder, neck, lower back, or knee pain experienced about 7 to 16 percent less chance of opioids.
For patients with shoulder, back or knee pain who used opioids, early physiotherapy was associated with a 5 to 10 percent reduction in the drug used.

Amid national concerns regarding the excessive use of opioids and encouraging the Centers for Disease Control and Prevention and other groups to use alternatives where possible, the findings provide evidence that physiotherapy may be a useful, non-pharmacological approach to controlling severe musculoskeletal pain.

The study, from an analysis of 88,985 claims from private health insurance for nine years for care and prescriptions between 2007 and 2015, was published in JAMA Network Open on December 14. The researchers assessed claims for outpatient and emergency care visits for the earliest case of shoulder, neck, knee, or low back pain in non-elderly families who were individually insured.
After correction for comorbidities, such as diabetes and hypertension, it was found that the chance of patients receiving an opioid prescription was lower three months to a year after their first pain diagnosis if participants had participated in at least one physical therapy session within 90 days of diagnosis. The chances were reduced by 16 percent for patients with knee pain, 15 percent for shoulder pain, 8 percent for neck pain and 7 percent for low back pain.

It has also been found that exercise therapy, part of physiotherapy, reduces pain for a number of musculoskeletal disorders and improves function. Other studies have shown that patients with previous prescriptions for opioid pain killers run an increased risk of overdose and abuse.

Physiotherapy within three months of diagnosis was also associated with a reduced likelihood that patients with two of the conditions would use chronic opioids in the long term, the study said. There was no association between physiotherapy and chronic opioid use in patients with shoulder or neck pain.

Sun explains that the general consensus implies that musculoskeletal pain opioids are generally not a long-term solution and, aside from all other side effects, even if the medicine is good for you, it will have less and less effect over time as your body builds up a tolerance.

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