Opioid Crisis: Exploring Physical Therapy as an Effective Alternative

The opioid crisis has been one of the most devastating public health issues in recent American history. For two decades, drug-related opioid overdose deaths have risen year over year. Considering the implications and costs of the crisis (estimated at almost 700 billion dollars in 2018 alone¹), many healthcare workers and public health professionals continue to struggle to combat the effects. So how did we get here? What can be done now? What alternatives exist to prescription pain medication?

History of Opioid Crisis

This crisis became evident in the United States during the early 2000s, as drug related overdose deaths began climbing. While the problem was first identified in the 2000s, the events that started this epidemic originated several years earlier, with the release of OxyContin in 1996. Following the release of this reformulated prescription, there was an intensified marketing campaign to bring awareness to prescribers of both the drugs impacts and a need for greater pain management for patients.  As a result, healthcare providers began to prescribe opioids at greater rates. This campaign ultimately resulted in a quadrupling of prescription opioid sales from 1999-2010.² 

Unfortunately, the large increase in prescriptions over the decade resulted in widespread misuse and dependency.  This resulted in the “first wave” of the opioid crisis. During this phase, the rise in deaths can be attributed to use of prescription opioids. However, by 2010, the crisis entered a “second wave,” characterized by a sharp increase in heroin-related overdose deaths. While it’s true that public health officials were aware of the growing trouble caused by prescription opioids and were taking efforts to reduce the volume of prescriptions written, those who had become addicted to opioid pain medication in the late 1990’s and early 2000’s were still trying to manage their dependency. As prescription drugs became harder to obtain, heroin, which had become more affordable and easily accessible fueled the second wave of deaths through 2015. By 2016, synthetic opioids – led by fentanyl – prompted the “third wave” of overdose deaths. Between 2016 and 2020, the rate of deaths again doubled to more than 20 per 100,000.

Current Statistics

The opioid crisis continued to escalate in the 2020s, with overdose deaths reaching alarming levels. According to the CDC, there were over 100,000 drug overdose deaths in the US in 2021, with opioids involved in 75% of cases. Fortunately, it would seem that overdose deaths may have peaked, as 2022 data suggests a leveling off.³ Furthermore, 2023 data indicates a 3% reduction in deaths compared to 2022.⁴

Does this mean that the epidemic is over? Absolutely not. There are still over a 100,000 Americans that die each year from drug related overdoses.⁴ So what strategies are being implemented to combat the epidemic? While the approach is multifaceted, ranging from law enforcement involvement to curb illegal drugs entering the country, to providing people with dependency issues treatment for their disorder⁵, arguably the best approach is to prevent the initial use of opioids all together.

In fact, the CDC released an updated Clinical Practice Guideline in 2022⁶ highlighting that “Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for specific conditions…” This clinical practice guideline goes further to highlight that opioids should be avoided for subacute and chronic pain as well.⁶

While opioids can assist with pain management, there are a variety of other pain controlling interventions (many of which are just as effective as opioids^6,7) that can be implemented to prevent exposing patient’s to addictive opioid drugs.

Physical Therapy as an Alternative

Physical therapy is a powerful, non-pharmacologic approach to managing and resolving certain types of pain⁵. Therapists are extensively trained to evaluate a patient’s symptoms and develop treatment plans which can include the following:

1. Manual Therapy: Techniques such as joint mobilization, neural mobilization, and myofascial/soft tissue manipulation can help reduce pain and improve mobility.
2. Exercise Therapy: Specific exercise programs tailored to the patient’s condition can strengthen muscles, improve flexibility, and enhance overall physical function.
3. Modalities: Treatments such as heat, cold, ultrasound, laser, and electrical stimulation can reduce pain and inflammation.
4. Trigger Point Dry Needling – For some patients, trigger point dry needling can be an excellent way to reduce pain and improve mobility. There’s even some evidence that TDN can help progress patients whose symptoms are more chronic and have struggled to progress with other treatment options.⁸
5. Patient Education: Teaching patients about body mechanics, posture, and ergonomics can prevent the recurrence of pain and injuries. Additionally, therapists can add context to imaging findings, provide detailed instruction on proper exercise performance, and discuss etiology of certain conditions to “demystify” diagnoses.

So how does physical therapy stand out as a superior intervention compared to an opioid prescription?

1. Non-Addictive Pain Relief: Unlike opioids, physical therapy does not carry a risk of addiction. PT focuses on treating the source of pain through movement, exercise, and manual techniques.
2. Long-Term Solutions: Physical therapy aims to provide long-term solutions to pain by addressing underlying issues such as muscle weakness, joint stiffness, and poor posture. This contrasts with opioids, which often mask pain without addressing its source.
3. Individualized Care: Physical therapists create personalized treatment plans tailored to each patient’s specific needs and conditions. This individualized approach can be more effective than the one-size-fits-all nature of opioid prescriptions.
4. Education and Empowerment: Physical therapists educate patients about their bodies and teach them how to manage pain independently. This empowerment can lead to better long-term outcomes and a reduced reliance on medications.

Opioids and Workers’ Compensation

Just in case the information listed above wasn’t convincing enough, let’s look at some research around workers compensation and opioid use. Studies have shown that workers prescribed opioids early in their treatment are more likely to experience longer periods of disability and delayed return to work compared to those treated with non-opioid alternatives like physical therapy.⁹ Furthermore, workers who receive opioid prescriptions are at an increased risk of opioid misuse, which can complicate recovery and impact their long-term employment. ¹⁰ One study even highlighted that opioid prescriptions written with 90 days of injury was “significantly and substantially associated with long term-temporary and permanent disabilitity”.¹¹ Considering all the negatives associated with opioid use in workers compensation, it’s crucial for all stakeholders to ensure injured workers are receiving care from healthcare providers that’s current, evidence-based, and in the long-term best interest of the injured worker.  Consequently, prioritizing non-pharmacological treatments like physical therapy can lead to better functional outcomes and reduce the risk of opioid-related complications for injured workers.

Conclusion

The opioid crisis remains a critical public health issue, but physical therapy offers a viable, effective alternative for managing and resolving pain without the risks associated with opioid use. By focusing on the root causes of pain and empowering patients with the tools they need to manage their conditions, physical therapy can play a pivotal role in reducing the reliance on opioids.

To learn more about how Physical Therapy and Upstream Rehabilitation’s family of brands can assist injured workers and Workers’ Compensation claims, contact our Workers’ Compensation team today!
 
Resources

1. The Full Cost of the Opioid Crisis: $2.5 Trillion Over Four Years https://trumpwhitehouse.archives.gov/articles/full-cost-opioid-crisis-2-5-trillion-four-years/#:~:text=One%20of%20the%20most%20tangible,period%20from%202015%20to%202018
2. The Opioid Crisis in the United States: A Brief History. (2022) Congressional Research Service. https://crsreports.congress.gov/product/pdf/IF/IF12260
3. Drug Overdose Deaths in the United States, 2002–2022 (CDC) https://www.cdc.gov/nchs/products/databriefs/db491.htm
4. U.S. Overdose Deaths Decrease in 2023, First Time Since 2018 (CDC) https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm#:~:text=The%20new%20data%20show%20overdose,2022%20to%2081%2C083%20in%202023
5. https://www.brookings.edu/articles/how-do-we-tackle-the-opioid-crisis/
6. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm?s_cid=rr7103a1_w
7. Effect of Opioid vs. Nonopioid Medications on Pain-Related Function in Patients with Chronic Back, Hip, or Knee Osteoarthritis Pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885909/
8. Dry Needling Combined with Physical Therapy in Patients with … – JOSPT. https://www.jospt.org/doi/full/10.2519/jospt.2017.7089
9. Relationship Between Early Opioid Prescribing for Acute Occupational Low Back Pain and Disability Duration, Medical Costs, Subsequent Surgery, and Late Opioid Use. Spine. 2007
10. Prescription opioid misuse in the workplace: Impact on costs and clinical outcomes. Journal of Occupational and Environmental Medicine. 2015
11. Early High-Risk Opioid Prescribing Practices and Long-Term Disability Among Injured Workers in Washington State, 2002 to 2013. Journal of Occupational and Environmental Medicine. 2020