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  • NIH Says Current Treatment of Chronic Pain Has Created 'Silent Epidemic;' More Focus Needed on Non-Drug Approaches

    According to a report recently released by the National Institutes of Health (NIH), it's time that treatment of chronic pain moves from a 1-pill-fits-all mindset to an evidence-based, individualized, multidisciplinary model that recognizes the value of nonpharmacological approaches, including physical therapy.

    The report (.pdf) is the product of an NIH panel that looked at the current state of treatment for chronic pain, which is estimated to affect 100 million Americans. In addition to looking into research on the issue, the panel convened a workshop that included more than 20 speakers. The results of the panel's work were published earlier this week (.pdf), and featured in the online edition of Time magazine.

    Much of the report is focused on the use—and possible overuse—of opioids as the "go-to" approach in almost all cases of chronic pain. In addition to contributing to patterns of drug abuse, the reliance on opioids may simply not be helping in all circumstances, according to the panel report.

    "Together, the prevalence of chronic pain and the increasing use of opioids have created a 'silent epidemic' of distress, disability, and danger to a large percentage of Americans," authors write. "The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm."

    The answer to that question, the panel found, is no. Patients with chronic pain are typically "'lumped' into a single category, and treatment approaches have been generalized with little evidence to support this practice," they write.

    Because the manifestations and response to pain can be so varied, the report calls for a variety of treatment options that include physical therapy, which is specifically mentioned in the report. These nonpharmacological treatments can be very effective—the problem, as one speaker at the workshop noted, is that "lack of knowledge or limited availability of these nonpharmacological modalities and the ready availability of pharmacological options and associated reimbursement structure appear to steer clinicians toward the use of … opioids."

    An NIH press release on the report quotes panel chair David B. Reuben, MD, as saying that "clearly there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches." The solution, he believes, is to ensure that "every patient's individual needs are met by a patient-centered health care system."

    The panel report cites many barriers to the implementation of such a system, including lack of substantive evidence-based research, limited physician access to experts in other disciplines, and some insurance plans' resistance to integrative treatment approaches. For now, authors write, the chronic pain landscape is one in which "large numbers of Americans are receiving suboptimal care."

    The release of the report comes at a time when the issue is receiving wider attention, thanks in part to Cake, a new film starring Jennifer Aniston as a women with chronic pain. Recently, the Washington Post addressed the issue in an article that called for a "blended approach" to chronic pain, including the use of physical therapy. That story followed up on a January 12 Washington Post article titled "8 ways to deal with chronic pain." The article's first recommendation: "embrace physical therapy."

    "The more you move, the better you feel," reporter Rachel Noble Benner writes in the article. "Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain, and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain."

    APTA has been at the forefront in helping the public understand how physical therapy can be a transformative agent in the treatment of chronic pain. The subject was featured in a Move Forward radio podcast, and the association offers a physical therapist's guide to chronic pain syndromes. Additionally, the APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT's role in chronic pain management was featured in the September issue of PT in Motion magazine.

    Comments

    • Physical therapy , medications in combination, ice, heat, massage, movement, counseling all work together - but is a continued effort and health benefits are very limited. Medications allow movement, exercise and return to some form of life/normal activities. For some it is the one component that allows for the rest of the therapies to be carried out. Without pain medications to keep me involved and active I would be suffering in a recliner losing my mind from The pain. Generalizations are very dangerous.

      Posted by Alison on 1/15/2015 12:24 AM

    • I'ts NOT 100 Americans in pain; it's 100 MILLION Americans in pain. And the DEA has put so many restrictions on the physicians that all pain patients are treated as drug addicts. That is not the case, either. Try living with back pain, foot drop, sciatica 24/7 without any hope of relief. Yeah, naproxen really helps.

      Posted by Colleen Meegan RN MSEd MSN on 1/15/2015 12:52 PM

    • For more than 20 years I've managed a forum for those with chronic pain which includes strategies for dealing with the day to day effects on one's life. Those effects are profound and wide ranging, impacting virtually all aspects of a person's activities, relationships and ability to make a living. Access to narcotics often makes a huge difference in the ability to deal with pain. Denial of access to relief from chronic pain is, to me, a serious breaking of faith with a patient who really needs help. The politicians who make these laws don't have a clue who they're actually hurting. Doctors who deny narcotics just don't understand chronic pain, which is governed by a different nervous system than acute pain. Bah. I could rant for hours. Suffice it to say that these programs are all well and good. Also, they work for many patients, but not all. And, not all can afford them, though perhaps with the affordable Care Act that will change.

      Posted by Dan Benson on 1/15/2015 11:31 PM

    • This is great news! I would love to share this on social media but the post could use some edits to correct typos.

      Posted by Matthew Burks -> BGQ`BO on 1/16/2015 6:15 PM

    • Check out Microcurrent Pain Systems and Frequency Specific Microcurrent.

      Posted by Bill on 1/16/2015 8:09 PM

    • I like that this article emphasizes the blended approach of pharmacological management as well as biopsychosocial aspect PT combines while addressing neurophysiological aspects of pain. It is understood that the physiologic change of nocicwptor registration is real.

      Posted by Jennifer K on 1/16/2015 10:15 PM

    • I am a physical therapist practicing myofascial release full time for 3 years. I practiced traditional physical therapy for 23 years; I have never looked back since beginning my practice in MFR. We are seeing remarkable results in decrease in narcotics, decrease in pain and a return to a balanced life style. The majority of patients we see are at the end of their road: the doctors have given up on them, prescribe pain medication, and tell them there is nothing more they can do for them. The fascial system is the missing link in health care. There is more evidence based research coming out on the fascial system. Most research is done in Germany and Canada....guess what...socialized medical systems. They are not worried about the all might dollar and whose pocket it goes into! Our business is consumer driven; we are not dependent on physician referrals. NIH needs to take a look at the FASCIA.

      Posted by Peg Owens, PT, MPH on 1/17/2015 1:06 PM

    • I am 88 and in physical exams, I would probably be in the top 10 percentile. My legs have ached for more than 60 years. It has never prevented me from an active life-hskiing, basketball, tennis, etc. The pain is in the muscles? behind knees and the area in the frontal area below the knee. It does not progress; it is probably 10 percent worse than several decades ago. It Ihas never, ant this includes up to the present, interfered with any activity. The worst part is it makes sleeping difficult as when you are still, one feels every pain. I have visited several pain clinics, used a variety of, pain killers, etc. with little relief. Also, I get the feeling, most medical professionals feel helpless and with little examinations are eager to give injections or try a few anti depressants. In fact not one of my providers have ever even touched the painfull areas. Of all the wonderful medical advances, I believe treatment of chronic pain is is one of medicine' greatest failures.

      Posted by Robert bytwerk on 1/25/2015 5:05 PM

    • How does PT help someone with the highest rated pain on the McGill Pain Scale above amputation cancer and childbirth? I'm talking about COMPLEX REGIONAL PAIN SYNDROME which feels like someone has poured burning acid on you and then the accompanying Allodynia which feels like someone has peeled back your skin and rubbed salt in it! Opioids are THE ONLY THING THAT WORK AND KEEP YOU FROM COMMITING SUICIDE!!! Oh, but no, let's have PT and mindfulness and biofeedback yoga and ALL THE OTHER CRAP SUGGESTED BY IDIOTS THAT WOULDN'T KNOW PAIN IF IT HIT THEM I THE ASS!!!! I AM SO FURIOUS WITH THE POLITICIANS AND DR. ANDREW KOLODNY AND HIS PROP MEMBERS WHO HAVE INVESTED IN SUBOXONE AND ADDICTION TREATMENT CENTERS FOR THE MONEY!!!! Dr. Kolodny owns a huge chain of addiction treatment centers (The Phoenix House), and he and PROP wrote the CDC 2016 Guidelines held in secret with no representation from any pain physicians patients or advocacy group!!!!! The Cochrane Report and other studies prove that people in moderate to severe pain ----less than 1% ever become addicted!!! The CDC lied when they said 72,000 people died of drug overdoses in 2016. They didn't separate the OD' s from opioids, and the number was 7,000 and among those all had taken them with other drugs like alcohol, cocaine, meth, etc. I could go on and on. The SUICIDE rate has gone up 30% because chronic intractable pain patients cannot live in constant severe, EXCRUCIATING SEVERE AGONIZING PAIN!!!! Opioids are the only drugs that don't cause organ damage unlike the NSAID'S and TYLENOL which cause kidney and liver damage requiring transplants! OPIOIDS ARE GOOD DRUGS!! I'LL SAY IT AGAIN OPIOIDS ARE GOOD DRUGS!!!! The corruption and evil of or Government (DEA, CDC, FDA, HHS, POLITICIANS,ETC.) HAS TAKEN US BACK TO THE DARK AGES. THE UN AND HUMAN RIGHTS WATCH HAS SAID THAT THE DENIAL OF PAIN MEDICATIONS TO PEOPLE IS TORTURE AND INHUMANE AND A VIOLATION OF BASIC HUMAN RIGHTS!!!!

      Posted by Jan on 10/6/2018 11:06 PM

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