Early Outpatient Physical Therapy Reduces Risk of Long-Term Opioid Use $0.00

Early Outpatient Physical Therapy Reduces Risk of Long-Term Opioid Use

By: Phil Page PhD, PT, ATC, CSCS, FACSM | Dec 28, 2018
Early Outpatient Physical Therapy Reduces Risk of Long-Term Opioid Use

Patients with musculoskeletal pain had significantly less opioid use if they started outpatient PT in the first 90 days after medical diagnosis…and starting after 30 days was even more beneficial.

Too often, we see musculoskeletal pain patients in physical therapy well after their pain started…sometimes after seeing several physicians who order a multitude of tests over the course of months. Medical management of musculoskeletal pain often includes radiological tests, specialist referral, and prescription pain medication…each of which can add unnecessary time and healthcare cost.

More evidence supports the use of physical therapy as an adjunct or alternative to pain medicine for musculoskeletal pain. The American Physical Therapy Association (www.apta.org) has launched a campaign, “#ChoosePT” aimed at increasing the awareness of the benefits of physical therapy, including their role in the opioid crisis. However, due to the prolonged time from diagnosis, many musculoskeletal pain patients do not see a physical therapist for months.

Researchers at Stanford and Duke wanted to know if there was a relationship between early outpatient physical therapy (defined as less than 90 days after a medical diagnosis) and subsequent opioid use in patients with new musculoskeletal pain. The researchers retrospectively evaluated healthcare data over 7 years from nearly 90,000 patients between ages 18-64. Patients had private insurance and were diagnosed by a physician. They focused on patients with neck, back, knee, and shoulder pain, since they are the most common reasons patients visit outpatient physical therapy. Patients with pain in multiple areas or a history of opioid use in 12 months prior were excluded.

The researchers defined ‘early physical therapy’ as at least 1 session of outpatient physical therapy within 90 days of the initial medical diagnosis. They adjusted the analysis to take other possible factors into account such as age, gender, and co-morbidities. After adjusting for potential confounding variables, early physical therapy was associated with a significant reduction (7-15%) in patients receiving an opioid prescription between 3 and 12 months after diagnosis of neck, back, knee or shoulder pain. In addition, the amount of opioid consumption was significantly reduced 5-10% in back, shoulder, and knee patients, but not neck patients.

Further analysis of the data revealed that:

  • receiving outpatient physical therapy less than 30 days after diagnosis was associated with much fewer opioid prescriptions, except for patients with knee pain
  • patients with lower back pain took fewer opioids if physical therapy was initiated less than 30 days after diagnosis
  • Chronic opioid use was significantly lower in patients with knee and lower back pain, but not neck or shoulder pain among patients receiving early physical therapy

In summary, early outpatient physical therapy reduced the probability of long-term opioid use by approximately 10% in patients diagnosed with shoulder, neck, back, and knee pain. Receiving physical therapy within 30 days after a medical diagnosis was associated with larger reductions in risk of opioid use for shoulder, neck and lower back pain patients.

These results were similar to several other studies supporting the role of physical therapy intervention as an alternative or adjunct to short-term opioid use in reducing the risk of long-term opioid use. The authors concluded, “The magnitude of these findings suggest that early physical therapy may provide mild to moderate protection against the risk and intensity of long-term opioid use for patients with severe musculoskeletal pain.”

The full paper is available for free download: Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain.

The Safer Pain Relief program (www.saferpainrelief.org) helps educate clinicians and patients on the benefits of conservative interventions such as physical therapy.

In new musculoskeletal pain patients receiving outpatient physical therapy less than 90 days after diagnosis, opioid use and consumption was significantly reduced between 3 and 12 months after diagnosis.

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