Abstract
Dear Editor,
I read with great interest the recently published article by Susan A. Randolph, MSN, RN, titled, “The Opioid Epidemic.” As a future physical therapist, it drew my interest as physical therapy may be considered an effective alternative for treating opioid addiction. I sincerely appreciated the attention you brought to the seriousness of the opioid epidemic and the war that needs to be won against opioids. However, I do believe that there is one thing that this article did not address that should be considered. Although this article examined how to safely use opioids, it did not mention any alternatives to opioids, so that opioids can be avoided. For example, physical therapy, nonopioid pharmacologic therapy (such as anti-inflammatories or steroids), and any other type of nonopioid pain interventions should be used as an initial treatment for pain.
According to Centers for Disease Control and Prevention (CDC) guidelines, opioids should always be used as a last line of defense against pain. “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” (“CDC: Physical Therapy, Other Non-Drug, Non-Opioid Approaches Should be First-Line Treatment for Chronic Pain,” 2016, p. 1). If these treatments can eliminate pain in the majority of instances, why are opioids still responsible for over 33,000 deaths per year? Lack of knowledge regarding alternative treatments for pain management may be the most significant contributor to the opioid epidemic.
A study was conducted in 2014 which revealed that 39% of individuals prescribed opioids increased their dosage without asking their physicians; 26% of the sample using opioids purposefully oversedated themselves; 18% of the sample used opioids for purposes other than what they were prescribed for; 12% hoarded their pain medication; and 8% secured additional opioids from another physician (Chou, 2014). These numbers are significant because the National Institute of Drug Abuse states that using opioids in any way that does not completely coincide with providers’ orders will likely result in addiction or other adverse reactions. In addition, the National Institute of Drug Abuse reported that each day more than 1,000 individuals are treated for the misuse of prescription opioids (“Prescription Opioid Overdose Data,” 2017).
A previous research has shown that opioids were effective in decreasing pain by an average of 12% to 30%; however, pain resumed when medication was withdrawn in nearly every case. In addition, 16% of these individuals still needed surgery after opioid treatment (Resnik, Liu, Mor, & Hart, 2008). Conversely, another study showed that pain decreased an average of 27% to 32% due to physical therapy (Díaz-Arribas et al., 2015). These findings support that physical therapy is an effective alternative to the use of opioids. In sum, I appreciate the author’s concerns regarding the opioid epidemic; however, the use of physical therapy and other nonopioid pain interventions should be the first line of treatment for pain.