As thousands of professional from the field celebrated National Physical Therapy Month throughout October, Sharon Dunn, PT, PhD, president of the American Physical Therapy Association (APTA) is joining local professionals including Karin LaBanca, PT, DPT, of fisio Physical Therapy and Wellness, LLC, in promoting physical therapy (PT) as another tool to help address the national opioid epidemic.

Since its inception in 1992, National Physical Therapy Month has provided an annual opportunity to recognize and celebrate the transformative power of physical therapy. But this year's event carries a special importance.

At the APTA, Ms Dunn is encouraging everyone in the profession to "serve as an ambassador for physical therapy" by reaching "beyond the walls of our clinics and classrooms to connect with the public at large."

"America is in the midst of a devastating opioid epidemic," she stated on the association's website, "and physical therapy has been identified as part of the solution by the Centers for Disease Control and Prevention and the US Surgeon General."

At fisio Physical Therapy and Wellness, LLC at 172 Mt Pleasant Road, Ashley Witson, PT, and Karin LaBanca, PT, take care of one patient at a time in private room settings incorporating massage, joint mobilization, stretching, and strengthening to reduce pain and swelling while also improving motion, strength, and function.

"We also educate patients on ways to reduce swelling that can be a major cause of pain especially following an injury or surgery, due to increased pressure," Ms LaBanca said. "During October, National Physical Therapy Month, we are part of a national public campaign encouraging people to choose physical therapy intervention in lieu of pain medications that have many dangerous side effects including risk of addiction."

CDC: Use Non-Drug PT

With overuse of opioids for the treatment of chronic pain becoming a national public health epidemic, the Centers for Disease Control and Prevention (CDC) recently released guidelines that recommend non-drug approaches such as physical therapy over long-term or high-dosage use of addictive prescription painkillers.

"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain," the guidelines state ("CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016" - March 15, 2016). "Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate."

While there are certain conditions - including cancer treatment, palliative care, and end-of-life care - where opioid prescription for chronic pain may be appropriate, the CDC cited numerous cases where opioid use could be significantly reduced or avoided altogether.

"The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT (cognitive behavioral therapy), and certain interventional procedures can ameliorate chronic pain," the guidelines state. "There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2-6 months.

"Previous guidelines have strongly recommended aerobic, aquatic, and/or resistance exercises for patients with osteoarthritis of the knee or hip," the guide continues. "Exercise therapy also can help reduce pain and improve function in low back pain and can improve global well-being and physical function in fibromyalgia."

Physical therapists partner with patients, their families, and other health care professionals to manage pain, often reducing or eliminating the need for opioids. Research has shown that a simple education session with a physical therapist can lead to improved function, range of motion, and decreased pain.

"Many people do not understand that acute or chronic pain is not always solely related to the specific injury one may have experienced," said Ms LaBanca. "Pain science, and the reason for constant or increasing pain is something those experiencing pain should be learning about."

She said that physical therapists can help explain the body's connective circuits and how pain may become worsened even if healing is present.

"Through education, manual therapy, therapeutic exercise, modality use and many other interventions, a physical therapist can help teach individuals pain management strategies to avoid or help decrease opioid use and addiction," she said.

Before agreeing to a prescription for opioids, Ms Dunn at the APTA urges patients to ask if physical therapy might be right for them.

When To Use PT

According to the CDC, patients should choose physical therapy when:

*The risks of opioid use outweigh the rewards - Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "Experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. Even in cases when evidence on the long-term benefits of nonopioid therapies is limited, "risks are much lower" with nonopioid treatment plans.

*Patients want to do more than mask the pain - Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.

*Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia - the CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.

*Opioids are prescribed for pain - Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with nonopioid therapies, such as physical therapy.

*Pain lasts 90 days - At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are "preferred" for chronic pain and that "clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."

Whereas opioids only mask pain, physical therapists treat pain through movement - with positive side effects like improved mobility, independence, and wellness.

"We use meditation techniques and gentle hands on techniques to reduce anxiety and depression that frequently accompany chronic and acute pain symptoms," Ms LaBanca said. "Physical therapy is an excellent option to provide pain relief and improve a person's confidence in their recovery without increased use of opioids."

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at #ChoosePT page, or contact fisio Physical Therapy at 203-270-2977, or visit fisiopt.com.

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