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  • TIME Article: US Must Rethink Pain Treatment, Become 'Insistent' on Physical Therapy

    A recent opinion piece in TIME magazine says that when it comes to pain treatment, unless a "fundamental mindset" is changed—a change that includes being "insistent" on the use of physical therapy in pain management—no real progress will be made in the fight to end the opioid abuse epidemic in the United States.

    In "We're All Responsible For Our Opioid Reliance—Even Patients," Andre Machado, chairman of the Neurological Institute at the Cleveland Clinic, describes how opioids are little more than a "quick fix" for pain that miss what should be the true goal of pain treatment, which he describes as "recovery of function, not complete resolution of pain."

    "This crisis is a failure of our health care ecosystem and our quick-fix culture," Machado writes. "We can all share the blame: physicians who feel anxious to meet patients’ expectations, pharma companies that oversell opioid benefits (and downplay the risks), insurers that fail to flag patients receiving high volumes of opioid prescriptions (and not properly reimbursing therapy) and patients who demand passive treatment."

    Machado argues that to truly change outcomes, "we all need to first change the metric of success" from focusing solely on the elimination of pain to helping patients better understand and manage their pain. Part of that shift, he writes, must include becoming "insistent on the use of physical therapy as an integral treatment component."

    As part of his own efforts to make that shift, Machado describes his participation in a Cleveland Clinic pilot program to treat more than 1,000 patients with chronic leg and back pain with physical therapy and counseling as a first-line response. The key metric of success, he writes, will be "restoration of function."

    "Ultimately, this methodology should serve to lessen the community's reliance on opioids and improve the utilization—and timing—of invasive procedures," Machado writes.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    Comments

    • Physicians do not treat patients with physical therapy, physical therapists do that. Physicians refer to physical therapists. Someone may want to get on that in medical schools and residency training programs. Physicians need to be taught and held accountable that their scope of practice is not endless and specifically that they do not remotely come close to knowing physical therapy. "We" as a "team" do not even understand that simple fact and that alone (the idea of a physician of a gatekeeper, know it all, and overseer of care) is responsible for untold havoc.

      Posted by Beedee on 8/19/2016 6:02 PM

    • Physical therapy works well for pain. The problem is insurance usually does not cover the cost. A patient has to go two or three times a week. Even with just having to shell out a co-pay, affording the treatment becomes impossible.I also wanted to go to a psychologist to learn how to manage my pain but my insurance does not cover it. This is not an unusual situation for most people. This is why my only alternative is pain medication. Not the best solution but the only option for many people.

      Posted by Sue on 8/20/2016 10:59 PM

    • Just because insurance will not cover something does not mean a patient cannot receive that something. When are patients going to value that something and decide to get it even if their insurance wont cover it? The best solution is not the one that hurts you less in the pocket.

      Posted by Louie Puentedura on 8/24/2016 4:17 PM

    • It is very rewarding to see how patients respond to knowing the reason for their pain. They are eager to learn strategies to deal with pain. The sooner they start PT the more effective they are in directing their behavior. Waiting years with only medication to cope with pain makes changes in pain behavior very difficult.

      Posted by Joan Firra on 8/24/2016 4:59 PM

    • I am a physical therapist and treat a lot of people with chronic pain. I managed these people with infrequent PT visits, typically every 2-5 weeks. There are plenty of things for people to do to manage their pain on their own and I am available to help "tweak" things. I think it is a really good model. What the public (and some PTs) need to realize is that the only thing that should happen in the PT clinic is what people can't accomplish on their own.

      Posted by Herbert Silver -> >JX^D on 8/24/2016 5:10 PM

    • The irresponsible abuse of pharmaceuticals stems directly from political lobbying by these billion dollar industries. They and the insurance industries that cover the 100s of dollars in cost for a 1 month prescription would be just as costly for the patient if reimbursed at the rate physical therapy is. The long term side effects add to the cost to the patient. Health is a priceless commodity. We should be willing to invest in it and not neglect it.

      Posted by Matthew St. Aimee on 8/24/2016 5:11 PM

    • Physicians are very skilled in their practice, but physical therapists are as skilled in their assessment of movement, strength, balance, and activity strategies. With chronic pain having such a huge impact on the person’s mind body, attitude, emotions, and outlook, more medication is not the quick answer. The best approach is to address each of these areas with psychology and counseling, non-opiod medication programming, and PT training. The physical rehabilitation will help the patient rethink what they can still do, retrain to do more before the s/s flare up and identify the triggers of the flare ups, and help to return them to better quality of life with new movement strategies and pacing of activities. It is the slow, steady, gentle, consistent progression that is really the most appropriate treatment to make the changes of a chronic condition. Like psychologist Dr. Ted Jones of Pain Consultants of East Tennessee suggests, if you think of treatment like a three legged stool (interventional, pharmacology, self-help skills instruction), when you neglect one of the footings then it is just an unstable approach and situation. It is the physical therapy functional rehabilitation approach using two of these three items (interventions, skills instruction) and complimenting the third item (pharmacology), that makes for the best outcomes. Thaddeus Mackiewicz, Jr, PT, MS, D, CSCS

      Posted by Thaddeus Mackiewicz, Jr. PT, MS, D, CSCS on 8/25/2016 12:32 PM

    • When third party payers finally come to the realization that physical therapy is more economical IN THE LONG RUN for most chronic conditions and pain, there will be a sea change. Ironically what might tip the balance in favor of P.T. are the 3-400% increases in cost for "old" drugs that have been on the market for years.

      Posted by Judith Florendo on 8/25/2016 2:36 PM

    • Unfortunately, many PTs still avoid these patients. We need to get the word out that a multi-faceted approach works with these patients. Pain science education needs to be supplemented with manual therapy, progressive but graded therapeutic exercise along with education on pacing, nutrition and stress management. Knowing how to treat these patients helps us think outside the box and makes us even better to serve other patients!!!

      Posted by Mary Fridlund, PT on 8/27/2016 10:21 AM

    • I agree with what others wrote above regarding cost. Unfortunately, cost for PT is currently prohibitively high and insurance coverage limited or low. This stems directly from our nation's healthcare policy and framework (favoring pharmaceutical intervention for chronic or recurrent conditions). Hopefully, as further evidence emerges for the benefits of PT and other conservative and cost-effective treatments, improved coverage (and diminished cost) will shift in the sensible direction. This is the shift that the article proposes. Could you please clarify the comment above that "the only thing that should happen in the PT clinic is what people can't accomplish on their own?" I agree that treatment should be a progressive program that involves constant monitoring of performance and modifications of interventions to ensure the best possible outcomes, and I would shudder to see a passive and static PT program. But that statement could also be misconstrued as advocating for manual therapy and modalities, rather than patient education or therapeutic exercise techniques (ie. patient-generated techniques). I'm just considering the patient who may come to rely on therapy (ie. manual therapy techniques or modalities) for recovery. Especially in cases of chronic pain, it is important that the an individual develop self-efficacy and self-reliance in their recovery in a multi-factorial approach. This may have just been my misreading the comment. Thanks for the clarification.

      Posted by RF on 8/29/2016 5:58 PM

    • I pay $35 copay for a physician visit, $35 copay for therapist visit, $3.00 for most medications.

      Posted by Ed Dieringer, PT on 9/17/2016 12:29 PM

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