Medicare Patients & Opioids

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.”

Want to see how your state is doing in this opioid epidemic?

In response to a growing opioid epidemic, the CDC released in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends nonopioid approaches including physical therapy. {We knew that!}

Patients should choose physical therapy when …

• … The risks of opioid use outweigh the rewards.
  Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.
• … Patients want to do more than mask the pain.
  Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
• … Pain or function problems are related to ,  or , or .
  The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
• … Opioids are prescribed for pain.
  Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with nonopioid therapies, such as physical therapy.
• … Pain lasts 90 days.
  At this point, the pain is considered “chronic,” and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are “preferred” for chronic pain and that “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Talk to your patients to discuss options for nonopioid physical therapy treatment. Help them #ChoosePT .

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.