Early Physiotherapy Cuts Opioid Use
Very often we see people in the clinic with musculoskeletal pain that has been ongoing for weeks, months, and sometimes years. It can take time to get a diagnosis as physicians order imaging, refer to specialists, and prescribe medications. Because of this prolonged time to diagnosis, many people suffering from musculoskeletal pain don’t get to see a physiotherapist for several months.
Stanford University researchers created a study to find out if there was a link between a delay in physiotherapy of more than 90 days and opioid use in people with musculoskeletal pain. Seven years of health data from 88, 985 patients 18 to 64 years old with neck, knee, shoulder, or back pain was analyzed. 26, 096 (29.3%) of these individuals received early physiotherapy.
Patients were included in the study that had received at least one physiotherapy visit within 90 days of their diagnosis and the researchers adjusted for other possible confounding variables such as comorbidities, age and gender.
The results of their research showed that people who received early physiotherapy were significantly less likely to receive an opioid prescription. Early physiotherapy was associated with a statistically significant reduction in the incidence of any opioid use between 91 and 365 days after diagnosis for patients with shoulder pain, neck pain, knee pain, and low back pain. For patients who did use opioids, early physiotherapy was associated with an approximately 10% statistically significant reduction in the amount of opioid use,
Further analysis also revealed that having physiotherapy within 30 days of diagnosis resulted in even better outcomes – further reductions in opioid use.
This December 2018 study published in Journal of the American Medical Association adds to the growing body of evidence supporting early physiotherapy as an alternative to or in addition to necessary short term opioid use. The researchers conclude “Early physical therapy appears to be associated with subsequent reductions in longer-term opioid use and lower-intensity opioid use for all of the musculoskeletal pain regions examined.”
Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open. 2018;1(8):e185909. doi:10.1001/jamanetworkopen.2018.5909
Contact us to schedule your physiotherapy as early as possible. We communicate directly with your family physician to expedite a diagnosis and coordinate the best care possible.
Russell | Feb 6, 2019 at 9:37 am
It is nice to see physical therapists working with researchers in medicine. The only problem I have with this study is that the date of pain onset should have been included. We only know the time from diagnosis. There may be individuals with chronic pain included that waited before seeing their family doc. Many people wait to see if their pain goes away on its own, or try massage, or rest before seeking treatment.
Janice | Feb 6, 2019 at 12:45 pm
That’s true, but it does add to a growing body of evidence demonstrating the value of seeing a physiotherapist sooner rather than later. Thanks for your comment Russell
KM | Feb 6, 2019 at 12:55 pm
You say this adds to the evidence.
Can you give me links to the articles
Janice | Feb 6, 2019 at 4:34 pm
Liu, X., Hanney, W. J., Masaracchio, M., Kolber, M. J., Zhao, M., Spaulding, A. C., & Gabriel, M. H. (2018). Immediate physical therapy initiation in patients with acute low back pain Is associated with a reduction in downstream health care utilization and costs. Physical therapy, 98(5), 336-347.
Childs, J. D., Fritz, J. M., Wu, S. S., Flynn, T. W., Wainner, R. S., Robertson, E. K., … & George, S. Z. (2015). Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC health services research, 15(1), 150.
Frogner, B. K., Harwood, K., Andrilla, C. H. A., Schwartz, M., & Pines, J. M. (2018). Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health services research.
G.P. | Feb 11, 2019 at 6:31 am
what about people that have a history of prior opioid use
Janice | Feb 11, 2019 at 5:17 pm
Patients with pain in multiple areas or a history of opioid use in 12 months prior were excluded from this study