The opioid epidemic has received a lot of attention over this past year, and for good reason. In 2016, there were 1,901 deaths in New Jersey due to opioid overdose (See an interesting article and interactive map here).(1) In New Jersey there have been nearly 6,000 deaths due to opioid overdose since 2004 and the rate of opioid overdose in New Jersey is 3x higher than the national average.(2) The federal government declared opioids a public health emergency and in 2017 the state of New Jersey started the “Facing Addiction Task Force to help combat the problem in our state.(3)
Opioid medications can be prescribed for pain after a surgery, a traumatic injury, or any severe pain. Any time opioids are prescribed there should be a clearly defined plan on how long to use the medication and how to transition from using it. Unfortunately, opioids have often been over prescribed with no clear plan to discontinue use. There is little to no research that supports the use of long term opioid pain medication for musculoskeletal pain.(4,5) Pain medication can help treat the symptom of pain but it does not get at the root cause of why you are having that pain in the first place. So, if you are currently dealing with a painful condition or on an opioid pain medication what should you do? Go see your physical therapist and consult with your doctor!
Your physical therapist can be your best teammate when dealing with a painful condition and to help you avoid the use of opioid pain medication. Especially with chronic pain, education is an extremely important component of treatment. Our nervous system works like an alarm system and under normal circumstances things that are painful need to meet a certain threshold to cause pain (see the dotted line “firing level below”). When the nervous system becomes “extra sensitive”, which is what happens with chronic pain, activites that normally would not be painful can now easily reach the pain threshold (“firing level” in the image below).
As an example - someone who has had back pain for years and has a nervous system that is in an “extra-sensitive” state, basic things like bending forward to tie their shoes can be painful. Understanding how pain works and working with a physical therapist who can help you better understand your specific situation is the best first step in treating pain.
At Performance Physical Therapy and Sports Conditioning we treat people who are in pain every single day. Unlike opioid pain medication there are no harmful side effects to physical therapy! We utilize multiple approaches to control pain including pain science education, manual therapy, and most importantly, exercise. With every patient that we treat our goal is to empower the patient with the confidence, knowledge, and ability to manage their own body. Check back next week when Coach Gerry of Challenger Strength discusses how he keeps his clients and athletes in top shape despite pain, bumps and bruises.
References and Useful Links:
4.Ballantyne JC. Avoiding Opioid Analgesics for Treatment of Chronic Low Back
Pain. JAMA. 2016 Jun 14;315(22):2459-60.
5 .Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI,
Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O'Connor PG,
Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts RG, Todd KH, Miaskowski C;
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel.
Clinical guidelines for the use of chronic opioid therapy in chronic noncancer
pain. J Pain. 2009 Feb;10(2):113-30.