Over the last 5 years, we’ve been bombarded with news stories, headlines and public service announcements about the rampant health crisis around opioids. Prescribed pain medications or opioids kill more people than cocaine and heroin overdoses combined. In towns across the United States, our first responders receive multiple calls per day due to opioid complications and overdose. 10 years ago, first responders dealt with 2-3 overdoses each month and now 25-30 overdoses are common. When prescriptions run out, people turn to street drugs to get the same high and the black market is full of prescriptions like oxycontin, oxycodone and percoset.
If this wasn’t depressing enough, opioids are intended to treat all types of pain. And it’s not working. One in 2.7 Americans lives with chronic daily pain, defined as pain lasting longer than 3 months. That’s more than 100 million Americans and over 1.5 billion people worldwide who suffer with chronic pain. While prescription opioids make sense for acute pain, severe trauma and end-of-life pain, there is no scientific evidence to support their long-term use, and there’s been no change in the rates of chronic pain. On the contrary, there is a large body of evidence that proves that long term use of opioids does damage, causes harm and may lead to addiction or death and is ineffective in treating chronic pain.
Pain and the Problem with Opioids
Pain is a universal experience
Without pain, we’d never know when our bodies were in danger. We’d put our hands on a hot stove, overuse our bodies with sports or cut our fingers when cooking dinner. Pain has a purpose and pain is normal. It triggers us to take action to protect our bodies from danger. Most acute pain resolves. When pain lingers around and becomes persistent and nasty, that’s when we go searching for a panacea. Enter opioids.
Opioids work on the brain rather than the body
The opium poppy binds to the receptors in the brain that affect mood and pain perception. By the way, exercise and acupuncture bind to these same receptors, and can provide the same pain relieving and mood elevating effects. Pain may still be present in the body but the opioid medication blocks the brains ability to feel it. Opioids do nothing to promote healing in the body; rather, they simply block your ability to sense the pain.
By taking too much or even taking the prescribed dosage, you are at risk for overdose because the opioid depresses the part of your brain that controls breathing. More commonly, taking opioids with other drugs like benzodiazepines quadruples your risk of overdose. As a physical therapist, I do not prescribe or counsel patients on medications of any kind. Over the years, many of my patients have not taken the risks of medication seriously, especially opioids. There is an implied “feeling of safety” because the opioid was prescribed by a doctor. Many of my clients seem unaware of the dangers of combining these powerful medications with alcohol, sleeping medications or other sedatives.
Side effects from opioids
Common side effects from opioid use are nausea, vomiting, itching, sweating, dizziness, drowsiness, hyperalgesia and constipation. When opioids are used for chronic musculoskeletal pain, many of my patients put up with some or all of these side effects and still experience very high levels of chronic daily pain. And, some have become tolerant or even addicted to the medication. About 5 percent of those people who stay on opioids for more than year will become addicted. Now they have both a pain problem and an addiction problem to solve. What started out as back pain becomes loss of employment, relationships and a normal life.
Prescriptions for opioids have quadrupled since 1999 and the costs associated with placing one person on opioids are about $6,000 per year. Misuse and abuse of opioids cost us about $60 billion dollars annually in the United States alone. Here’s a thought about treating chronic pain appropriately and safely: If we spent $2,000 per year per individual on early, effective interventions for musculoskeletal pain like physical therapy, acupuncture and lifestyle changes, we would eliminate chronic pain and all the societal issues that come with it. Compared to opioids, physical therapy can’t be sold on the black market, you won’t lose your job from participating in physical therapy, you won’t get constipated, itch or vomit. And physical therapy can’t kill you!
Physical Therapy for Alternative Pain Management
As a physical therapist that specializes in treating chronic, complex patients, I ask myself one simple question every time I meet a new client with chronic orthopedic pain: Why hasn’t their body healed after 60 days, 90 days, or one year? When orthopedic injuries occur, most heal in about 100 days. If the body is still hurting, why is that? Causes of persistent pain can be found in the body where mechanical stresses continue to injure it or they can occur in the brain itself. Most commonly, we find a combination of both in our chronic clients.
Remove the mechanical triggers
For some chronic pain, the body is under regular mechanical stress that is injuring or irritating it. In physical therapy, it’s the physical therapist’s job to identify the root causes of pain. Once identified, the triggers can be removed and the body can progress through its natural healing cycle. For example, regular poor sitting at a computer may be a root cause for chronic neck pain and headaches. In physical therapy, we change the sitting posture, work on the stiff areas of the neck, strengthen the muscles that hold the neck up all day and create exercises that promote healing. If we continue to provide the body what it needs, it heals in 2-3 months and the pain resolves.
Treat the brain
If your pain has persisted longer than 30 days, your brain has changed. By now, your brain has re-wired around the pain and has become more sensitive to pain and more vigilant. The brain perceives your body is in danger and produces more pain to keep you safe. In physical therapy, you will learn about neuroplasticity and its relationship to chronic pain. By understanding the physiology of pain and applying techniques to re-wire your brain and calm your system, you can recover from chronic pain.
Exercise, Exercise, Exercise!
Therapeutic exercise prescribed by a physical therapist is essential in the recovery from chronic pain. Your body is meant to move and it’s meant to enjoy and like movement. When movement and exercise become associated with pain, it’s a problem. As part of an alternative pain management strategy, a physical therapist will reintroduce exercises that help you recover. Exercises appropriate for chronic pain are cardiovascular exercises like walking, biking or jogging, stabilization exercises to help you stay upright all day, stretching and strengthening. Once the injury is identified, the mechanical triggers remove and the brain retrained, your body will be ready for exercise essential to its recovery. For many of my patients, exercise is not their favorite. I encourage them as I will encourage you that your body is meant to move. The body is designed to be active, not sit. The body is designed to be strong, bend, move and stretch. When you use your body as it’s meant to be used, it usually works better. When it works better, it feels better.
If you are in chronic pain right now or know someone who is, see a physical therapist. We know how to help you and want to see you get back to a normal life again. Persistent and chronic pain is not a natural state of our bodies. The chronic pain is a sign that something is out of balance, and you need to take action to help your body recover.
Should you have any questions, feel free to email us directly at firstname.lastname@example.org. If you live in the Portland, Oregon area, contact Life’s Work Physical Therapy at 503-295-2585 or visit www.lifesworkpt.com to schedule an appointment. If you live outside the Portland area, please refer to my previous blog on How to Find a Good PT and visit apta.org to locate a physical therapist in your area. Get a PT who specializes in the treatment of chronic musculoskeletal pain on your team and get to your life again. Chronic pain is highly treatable and highly preventable. Please get help if you are suffering.
My warmest and most sincere wishes for your recovery.
Sandra Stryker, PT, MPT, COMT, FAAOMPT