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  • Fighting the Opioid Crisis: APTA Releases White Paper Pointing the Way to Better Policies on Nondrug Pain Treatment

    A new white paper from APTA makes one thing clear to anyone looking for strategies to combat the opioid crisis in the US: no lasting gains can be made in the fight until stakeholders and policymakers in the country's health care system embrace the value of nonpharmacological approaches to chronic pain. And that embrace, APTA says, must include policy changes that increase patient access to physical therapy, as well programs that make it easier for health care providers to work in underserved communities especially hard-hit by the epidemic.

    In its new white paper titled "Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health," APTA points out how the rise of opioid misuse and addiction rates can be linked directly to the widespread use of prescription opioids for the treatment of pain. In the last few years, that stark reality has in turn led to "a growing realization that current strategies for managing pain have to change—that opioid-centric solutions for dealing with pain at best mask patients’ physical problems and delay or impede recovery and at worst may prove to be dangerous and even deadly."

    APTA isn't a newcomer to the opioid fight. The association's involvement dates back to late 2015 and includes the award-winning #ChoosePT public awareness campaign. The white paper is a comprehensive summary of the problem and APTA’s recommendations to address it.

    "Moving forward, the health care system must reexamine its approach to pain, including how causal factors are identified, what tools or measures are used to quantify its impact, and how the approach to treatment is aligned with the patient’s goals and values," the association says in the paper.

    To help fuel that reexamination, the white paper provides a history of the use of opioids in pain treatment, an examination of concepts around pain, and case scenarios that demonstrate how treatment by a physical therapist (PT) can help patients reduce or eliminate opioid use. With context in place, the association then sets out 6 recommendations that it believes need to be part of "a comprehensive response to the opioid crisis:"

    • Better public awareness of pain assessment and options for pain management
    • Public and private health plans that include "benefit design, reimbursement models, and integrated team approaches that support early access to nonpharmacological interventions, including physical therapy, for the primary care of pain conditions
    • Reduction or elimination of patient out-of-pocket costs and increased "access to and payment for person-centered, nonpharmacological pain management and treatment interventions"
    • Stepped-up efforts by health plans to educate providers on the effectiveness of nonpharmacological approaches to pain treatment and best practices in assessment, treatment, and referral
    • Greater attention by policymakers to what's working in pain management care, and a willingness to commit to lower patient out-of-pocket costs and innovative approaches, including bundled-care models and the use of multidisciplinary teams
    • Federal and state student loan repayment programs that incentivize health care professionals to work in underserved communities, thereby increasing the availability of health care providers in areas disproportionately affected by the opioid crisis

    "The opioid crisis is a complex societal and public health issue," said Katy Neas, APTA executive vice president of public affairs. "This white paper addresses a major factor that has fueled this crisis, but there's much work to be done on multiple fronts. APTA and its members can be key contributors in what is truly a life-or-death fight."

    Comments

    • All the references to pain and not to the condition causing the pain, makes it sound like the pain needs to be addressed. The real value of PT is addressing the problem that causes the pain. MDs can only treat the pain and not the cause. Medication is for the pain, maybe the anti-inflammatory medication is for a factor in the cause but still not the real cause.

      Posted by Shirley A Sahrmann on 6/20/2018 10:16 PM

    • What is the “real cause” of pain?

      Posted by Jeremy Fletcher on 6/21/2018 8:52 AM

    • Shirley that was a beautiful statement. Also, let's not pretend that this opioid problem was NOT intentional. It is yet another example of following the money. The manufacturers and insurance companies and our congress have all been very complacent happily profiting from opioids for decades. We, as well as many other options, have always been a solution. Until we figure out how to make us an affordable, first-line option, the problem with continue. The solution has always been here. Do we really expect the people who caused and profit from the problem to want to fix it? The outcry must continue!

      Posted by Ehren Trost on 6/22/2018 10:18 AM

    • As long as the “public” (ie let’s vote to legalize another drug for the masses and bypass public health concerns for the next generation) is looking for an easy way out to dumb down sensation to help us all” cope” with life we will as providers be extremely challenged. Be ready for resistance from even the potential clients we could help who still don’t know how much they need what we offer. Pain management is also about changing public mindset to get society to embrace what physical therapy can offer, to say no to drugs as an option, and empower individuals to take more responsibility for themselves and be willing to invest in their health over the long haul. Unfortunately, most people these days don’t make that kind of change easily. And we are waiting for insurance companies to get on board? We need to be more proactive. Sometimes things (just say entitlement programs) need to be taken away before people start resourcing better options. Also, if MD’s stop prescribing pain medication and send a referral instead (just say state/federal legislation) we would be off to a good start for those who are already covered by insurances. However, is our profession truly ready for the masses? Still feel like we are swimming upstream a bit on this, with a lot of work to do in many sectors, and the solution is truly multi-factorial, but it is well worth the effort, and when the tide shifts hopefully our profession will be very well prepared, even better than we already are. There is still work to do in being more proactive in our profession, all of us, in our communities, and with our legislators, so that when people (clients, MD’s, the public at large) really do start looking, they will know we are there for them.

      Posted by Kelly on 6/26/2018 12:16 AM

    • Wow! Interesting comments here. Here is a slightly different perspective. First - Ask WHY. If we think in a patient-centered way, what the patient wants is to reduce or eliminate their pain. They are far less concerned about the cause. Why should a physician refer a patient to a PT? Physical therapy offers a human, interactive approach to relieve a patient's pain. We think about the HOW. How is physical therapy going to relieve this patient's pain? For that, the PT has to know the often complex cause and the heavy psychological baggage that comes with it. Then, ask WHEN. When will physicians start referring more to physical therapists? When we can consistently demonstrate and deliver timely, effective results. To delivery those timely, effective results, we really do need more help from insurers to give us enough time (and money) to make a measurable difference. Three visits per week just isn't enough in my experience. Evidence-based therapeutic tools and techniques that produce measurable/reportable results, including patient satisfaction, will do more to persuade physicians to refer than unlikely legislation. Given all of the different "real causes" of pain, has our profession done enough to show we can be more effective than narcotics in each and every pain category? As one of the commentators above said, there is a lot more work to do if we want to be a reliable resource in the fight to reduce opioid abuse. Good luck to the pilot program volunteers - show them what we can do!

      Posted by Marc Gelinas on 7/13/2018 6:59 PM

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