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  • Opioid Prescription Study Sparks Talk of Nondrug Approaches to Chronic Pain

    A new study on access to prescription opioids has garnered media attention—and triggered more discussion about the need for physicians to more carefully consider other treatments for chronic pain, including physical therapy.

    The study, covered by Reuters, The Boston Globe, and other media outlets, found that more than 90% of individuals who survived a prescription drug overdose were able to get another prescription for the same drug after the overdose. And it would seem that for the most part, it wasn't that hard to do—70% of the people who obtained the postoverdose prescription got it from the same physician who prescribed it earlier.

    Quoted in the Reuters article, lead study author Marc Larochelle, MD, said that a possible explanation for the "surprising and concerning" results is that "providers are not aware that their patients experienced an overdose when making the decision to continue prescribing opioids."

    The Boston Globe characterized the study as one that suggests "major gaps in communication, education, and oversight."

    Closing those gaps will require physicians to pay careful attention to signs of opioid abuse among their patients and to consider treatments other than opioids for chronic pain, according to Larochelle.

    "In addition to any potential opioid use disorder, we need to communicate alternative options for treatment of chronic pain, and all modalities should be considered, including nonopioid medications, physical therapy, and complementary and alternative treatments," Larochelle told Reuters.

    Jessica Gregg, MD, who wrote an editorial that accompanies the study, echoed Larochelle's points, telling Reuters that "in a perfect world, a physician would be able to work with a team that might include physical therapists and/or occupational therapists, alcohol and drug counselors," and others with related expertise.

    In the Globe article, Gregg says that while effective, treatments that rely less heavily on opioids are "slow fixes" that the current health care system isn't "particularly well set up" to accommodate. She characterizes physical therapy and emotional health treatment as "things that will help, but not quickly."

    The study, published in the Annals of Internal Medicine (abstract only available for free), surfaced in the media not long after the US Centers for Disease Control and Prevention (CDC) issued a report stating that drug and opioid overdose deaths in the US rose dramatically in 2014, to 14.7 per 100,000 persons. That's an increase of 6.5% over the 2013 rate, part of a trend that has amounted to 137% increase in overdose death rates from all drugs since 2000. Death rates from opioid pain relievers and heroin increased by 200% during that same time.

    APTA has taken an active role in bringing the physical therapy perspective to the fight against prescription drug abuse and heroin use, and is currently participating in a public-private White House initiative to combat the problem. In addition to APTA, initiative participants include the American Medical Association, the American Academy of Family Physicians, the American Nurses Association, the American Public Health Association, the American Academy of Hospice and Palliative Medicine, and the American College of Osteopathic Surgeons.