APTA isn’t a newcomer to the opioid fight. The association’s involvement dates back to late 2015 and includes the #ChoosePT public awareness campaign. The white paper below is a comprehensive summary of the problem and APTA’s recommendations to address it.
“Moving forward, the health care system must reexamine its approach to pain, including how causal factors are identified, what tools or measures are used to quantify its impact, and how the approach to treatment is aligned with the patient’s goals and values,” the association says in the paper.
To help fuel that reexamination, the white paper provides a history of the use of opioids in pain treatment, an examination of concepts around pain, and case scenarios that demonstrate how treatment by a physical therapist (PT) can help patients reduce or eliminate opioid use. With context in place, the association then sets out six recommendations that it believes need to be part of a comprehensive response to the opioid crisis:
- Better public awareness of pain assessment and options for pain management
- Public and private health plans that include “benefit design, reimbursement models, and integrated team approaches that support early access to nonpharmacological interventions, including physical therapy, for the primary care of pain conditions
- Reduction or elimination of patient out-of-pocket costs and increased “access to and payment for person-centered, nonpharmacological pain management and treatment interventions”
- Stepped-up efforts by health plans to educate providers on the effectiveness of nonpharmacological approaches to pain treatment and best practices in assessment, treatment, and referral
- Greater attention by policymakers to what’s working in pain management care, and a willingness to commit to lower patient out-of-pocket costs and innovative approaches, including bundled-care models and the use of multidisciplinary teams
- Federal and state student loan repayment programs that incentivize health care professionals to work in underserved communities, thereby increasing the availability of health care providers in areas disproportionately affected by the opioid crisis
You can help move the conversation forward about the valuable role the physical therapy profession can play in improving patient outcomes and combatting the opioid crisis by reading the white paper below and creating awareness in your community.
Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health
An American Physical Therapy Association White Paper
June 1, 2018
EXECUTIVE SUMMARY
The ongoing opioid crisis in the United States reflects the unintended consequences of a nationwide effort to help individuals control their pain. The health care system has, since the mid-1990s, employed an approach to pain management that focuses on the pharmacological masking of pain, rather than treating the actual cause(s) of the pain when its source can be identified. This strategy has resulted in a dramatic increase in opioid prescribing, causing widespread opioid misuse and addiction. It also has led, in the last few years, to a growing realization that current strategies for managing pain have to change—that opioid-centric solutions for dealing with pain at best mask patients’ physical problems and delay or impede recovery and at worst may prove to be dangerous and even deadly. Moving forward, the health care system must reexamine its approach to pain, including how causal factors are identified, what tools or measures are used to quantify its impact, and how the approach to treatment is aligned with the patient’s goals and values. Ensuring that patients and families are aware of and have access to various options for care is a significant step in addressing this complex issue. This report examines the opioid epidemic and the impact it has had on patients, their families, and the nation as a whole. It also affirms that physical therapist interventions are an essential component of the multidisciplinary undertaking that will be required to improve patient outcomes and alter the trajectory of this public health crisis.
INTRODUCTION
The presence of pain is one of the most common reasons people seek health care. National surveys have found that chronic pain – defined as pain lasting longer than three months – affects approximately 100 million American adults and that the economic costs attributable to such pain approach $600 billion annually.
Pain has been described in the medical literature as a “uniquely individual and subjective experience” and “among the most controversial and complex” medical conditions to manage. The source of pain for any individual can vary, whether it’s an underlying illness such as heart disease or cancer, an injury experienced recently or long ago, or the lingering effects of a medical procedure. Regardless, a report on the subject by the US Department of Health and Human Services (HHS) notes that pain and its treatment “can be a lifelong challenge at the individual level and is a significant public health problem.” Moreover, there may not always be a peripheral source of persistent pain. Changes in the central nervous system perpetuate persistent pain, as in the case of individuals who have had both legs amputated feeling pain in their feet.
The treatment of pain, particularly chronic pain, often requires an integrated, multidisciplinary approach due to the many variables that may contribute to a patient’s perception of pain and response to treatment. These variables can include the underlying cause(s) of the pain and the anticipated course of that condition, the available and accessible options for pain prevention and treatment, and the patient’s personal goals, values, and expectations around health care. When individuals enter the health care system because of pain, their prospects for recovery—both immediate and long-term—are highly dependent on the system’s response. Nationwide, HHS reports, patients with pain “face many systemic hurdles to appropriate care.” Evidence suggests, the department adds, “that wide variations in clinical practice, inadequate tailoring of pain therapies to individuals, and reliance on relatively ineffective and potentially high-risk treatments such as inappropriate prescribing of opioid analgesics…not only contribute to poor-quality care for people with pain, but also increase health care costs.”
That evidence, in fact, was the driving force behind recent recommendations by the US Centers for Disease Control and Prevention (CDC) in its “Guideline for Prescribing Opioids for Chronic Pain.
“The CDC states that “Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain.” The report expands on this thought, suggesting that “many nonpharmacologic therapies, including physical therapy…can ameliorate chronic pain.”
Physical therapy is a dynamic profession with an established theoretical and scientific basis for therapeutic interventions capable of restoring, maintaining, and promoting optimal physical function.
Physical therapists work both independently and as members of multidisciplinary health care teams to enhance the health, well-being, and quality of life of their patients, who present with a wide range of conditions including those that commonly cause pain. The CDC’s recommendations point to “high-quality evidence” that treatments provided by physical therapists (PTs) are especially effective at reducing pain and improving function in cases of low back pain, fibromyalgia, and hip and knee osteoarthritis. Additionally, a number of studies show the efficacy of physical therapist interventions in preventing, minimizing, and, in some cases, eliminating pain in patients postsurgery, in patients with cancer, and in other clinical scenarios.
Modern society too often puts a premium on quick-fix solutions to complex problems. This is evidenced by the prescription drug consumption in the United States. According to the CDC, approximately 9 out of every 10 Americans who are at least 60 years old say they have taken at least one prescription drug within the last month. Children in the United States are three times more likely to be prescribed antidepressants as children in Europe are. When it comes to pain and prescribing opioids, this desire for a quick fix not only can be counterproductive, it also can be dangerous. Often when individuals experience pain, nonopioid options are safer, more effective, and longer lasting. Incorporating such options as standards of practice should be a central tenet in addressing the opioid crisis.
To be clear: opioids have a role in addressing pain. While we examine the use of opioids as an inappropriate first strategy for too many patients, we also must ensure that we do not limit access to opioids for patients for whom they are a needed component of care. Just as a failure to effectively manage and treat pain is not solved by prescribing too many pills, limiting access to medications for those who genuinely need and benefit from them is not a person-centric or appropriate course of action.
This report describes the opioid crisis and explains how PTs can contribute to its solution. It presents evidence documenting the effectiveness of physical therapist interventions in treating pain and preventing the onset of chronic pain, thus, quite likely, reducing opioid use. This report also lists recommendations to providers, payers, and others who are in a position to change the way the system works. It is time for health care to look beyond opioids—and to use proven nonpharmacological strategies, including physical therapist treatment, to transform pain management in an effort to improve the health of those at risk for developing or living with chronic pain.
CONCLUSION
The National Quality Forum (NQF), a leading health care research and advocacy group, recently announced the formation of an Opioid Stewardship Action Team to address the opioid epidemic. The team, which includes representatives from the CDC, the American Society of Health System Pharmacists, and the American Physical Therapy Association (APTA), among others, has developed what it describes as a “playbook” that will focus on “improving prescribing practices and identifying strategies and tactics for managing care of individuals” at risk of opioid dependence. Other programs also have been launched to help bring the opioid crisis to an end—ranging from an event led by the Academy of Integrative Pain Management called the “Integrative Pain Care Policy Congress” to APTA’s own #ChoosePT opioid awareness campaign, which encourages consumers and prescribers to follow the CDC’s opioid-prescription guidelines.
The take-home message from each of these initiatives is that the opioid epidemic is a complex problem that will be solved only through multidisciplinary collaboration, and that individuals with chronic pain must be offered interventions that not only control pain but also address the causes of pain. The CDC, NQF, and other major health agencies and organizations all have affirmed that nonpharmacological and nonopioid therapy can be effective in managing chronic pain. It’s time for the health care system to look beyond opioids to options such as physical therapist interventions that treat pain and combat chronic pain by addressing its source(s).
For more info or to read the entire 16 page paper, please see the link below:
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