PT May Reduce Risk, Amount of Long-term Opioid Use

Patients who underwent physical therapy (PT) soon after being diagnosed with pain in the shoulder, neck, low back, or knee were approximately 7 to 16 percent less likely to use opioids in the subsequent months, according to a study by researchers at the Stanford University School of Medicine and the Duke University School of Medicine.

For patients with shoulder, back, or knee pain who did use opioids, early PT was associated with a 5 to 10 percent reduction in how much of the drug they used, the study found.

Amid national concern about the overuse of opioids, the findings provide evidence that PT can be a useful, nonpharmacologic approach for managing severe musculoskeletal pain.

The researchers found that the odds of patients filling an opioid prescription three months to a year after their initial pain diagnosis were lower if they had participated in at least one PT session within 90 days of their diagnosis. The odds were reduced by 16 percent for patients with knee pain, 15 percent for shoulder pain, 8 percent for neck pain, and 7 percent for lower back pain.

“This isn’t a world where there are magic bullets,” said the study’s lead author Eric Sun, MD, PhD, of Stanford. “But many guidelines suggest that physical therapy is an important component of pain management, and there is little downside to trying it.”

The study also measured whether early PT was associated with a decreased need for opioids in the long term among patient who filled prescriptions.

The researchers found that patients who had undergone early PT used 10.3 percent less opioid medication for knee pain, 9.7 percent less for shoulder pain, and 5.1 percent less for back pain in the period three months to a year after their diagnosis. There was no significant reduction for neck pain.

PT within three months of diagnosis also was associated with a decreased likelihood that patients with two of the conditions would chronically use opioids in the long term, according to the study. After early PT, patients with knee pain were 66 percent less likely in the period three months to a year after their diagnosis to either fill ten or more prescriptions or acquire a supply of opioid medication for 120 days or more. Patients with low back pain were 34 percent less likely to be chronic users if they had early PT. There was no association between PT and chronic opioid use among patients with shoulder or neck pain.

“The general consensus is that for musculoskeletal pain, opioids generally aren’t a long-term solution,” Sun said. “Aside from all the other side effects, even if the medication is doing well for you, it will have less and less effect over time as your body builds up a tolerance.”

The study was published in JAMA Network Open.

This article was adapted from information provided by Stanford Medicine.

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