By Jerry Moczerniuk, P.T., D.P.T.
Over the last several years there has been a nationally recognized public epidemic of overuse of opioids for the treatment of chronic pain. The Centers for Disease Control and Prevention (CDC) have recently released guidelines that recommend nondrug approaches such as physical therapy over long-term or high-dosage use of addictive prescription painkillers.
Pain is an uncomfortable feeling, both sensory and emotional. It can be sharp, dull, steady, throbbing, aching, or may even be described in many other ways. Pain can simply be a nuisance, like a mild throbbing from a bee sting. Other times it can be absolutely debilitating and may significantly impact all aspects of a person’s life, including their job, daily activities and relationships.
In medicine pain is classified as either acute or chronic. Acute pain typically comes on suddenly, is severe and short-lived, often caused by an injury to soft tissue (muscle, tendon, skin, organs), or bone. Chronic pain on the other hand is present for extended periods of time, sometimes years, and may even last for life. Chronic pain is usually associated with a long-term disease or illness such as osteoarthritis. In America more than 100 million people live with chronic pain. Acute pain may in fact lead to chronic pain, which may require constant and ongoing treatment.
Pain is ultimately considered a symptom, and it should be accurately assessed in order to be properly treated. Treating pain itself may not address the root cause of pain. Recent studies reveal that medications and injections may simply mask the pain, but not address its underlying etiology.
A 2014 National Institutes of Health review found that there is “no evidence for effectiveness of long-term opioid use for chronic pain, but a disquieting amount of evidence for harm, including overdoses and addiction.”
In 2016 the CDC created guidelines in response to growing rates of opioid use disorder and opioid overdose. The CDC guidelines state that “Nonpharmacologic therapy, such as physical therapy, and nonopioid pharmacologic therapy are preferred for chronic pain,” and that “the contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as [cognitive behavioral therapy, or CBT], and certain interventional procedures can ameliorate chronic pain.” Furthermore, the guidelines state that both stress that nonopioid therapies should be “tried and optimized” before considering opioid prescription.
A physical therapist can evaluate your pain, and treat the pain with therapeutic modalities (cold laser therapy, ultrasound, electrical stimulation therapies), hands-on techniques, and through prescription of therapeutic exercises. Lifestyle changes and activity modification may also be necessary to better treat the pain. Over the years research has proven the benefits of all of the above stated interventions for treating pain.
A physical therapist should be considered a great option for evaluation and treatment of acute and chronic pain. Remember, in New Jersey you can be evaluated and treated by a physical therapist without a referral from your doctor.
Dr. Moczerniuk is a doctor of physical therapy, member of American Physical Therapy Association, and a clinical director at db Orthopedic Physical Therapy of Manalapan LLC, located at 120 Craig Road, Suite 2. Dr. Moczerniuk can be reached at 732-462-2162 or via e-mail at [email protected]. You can also find out more about the practice at dborthopt.com.