It's Not Just Consumers Who Must Think Differently About Pain
By Steven Z. George, PT, PhD
The United States is in the midst of a costly and deadly opioid epidemic. There are no easy answers to this problem, but physical therapists could be a big part of the solution. Physical therapy's potential for effective pain management has already been recognized by a Centers for Disease Control and Prevention (CDC) initiative indicating that physical therapy should be a front line option for patients with chronic pain conditions. In response, APTA initiated the #ChoosePT campaign to let patients and providers know that physical therapists are a viable early option for pain management.
These are exciting developments, and they bring new opportunities and challenges to our profession. The opportunity is clear: a move away from widespread opioid use could allow more patients with pain to benefit from physical therapy, which offers pain relief that is effective and does not carry the risks associated with opioid use.
The challenge is that if our profession is to become more adept at pain management, we will need to think and act differently about pain. In particular, physical therapists must be willing to change theories and clinical practices that have persisted despite their lack of evidence as being part of an effective pain management strategy.
When I delivered the Maley Lecture at the 2016 NEXT Conference & Exposition, I warned against “silver bullet” treatments – sometimes involving special training, techniques, or equipment – that focus on complete relief of chronic pain. Not only do these approaches risk giving patients unrealistic expectations, they also fail to deliver when tested rigorously in clinical settings, and we end up offering nothing new or improved to our patients.
Physical therapists are uniquely situated in most health care systems to exert considerable leverage for improving acute and chronic pain management. However, to have the largest impact there must be a revolutionary change in our education and practice. Physical therapists must also consider that our biomechanical tendencies are not always well aligned with progressive pain management.
Most immediately, physical therapists must acknowledge that pain is a complex, individual experience, and pain can be affected by many factors in a person's life. In my lecture, I explored the pain experience of someone getting a tattoo to illustrate the profound influence of context on pain ratings.
We know that physical therapy is a safer choice than long-term opioid therapy. But for physical therapist treatment to be solidified as an effective first choice for pain management, we need to ensure that clinical behaviors align with a nuanced understanding of the pain experience.
We need a pain management revolution.
Steven Z. George, PT, PhD, is director of clinical research, Department of Orthopaedics, and director of musculoskeletal research, Duke University Clinical Research Institute. For more of George's perspectives on pain management, watch the video from NEXT 2016's Rothstein Roundtable, "Opioids Versus Physical Therapy: Should Physical Therapy Be the First Choice for Pain Management?"
Explore other posts from the "Narrow the Gap" series.