Impact of Early Physical Therapy on Opioid Usage in Musculoskeletal Pain Patients

Understanding the Opioid Crisis

A recent study explored the connection between early physical therapy and opioid use among patients suffering from musculoskeletal pain. The misuse and abuse of opioids have reached epidemic levels in North America, resulting in numerous fatalities and overdoses. This situation is recognized as a significant public health concern, prompting experts to advocate for more effective strategies to address the crisis. Opioids are often prescribed to individuals experiencing severe musculoskeletal pain, a condition affecting nearly half of the American population, thereby increasing the risk of opioid misuse. In response, many health organizations are now promoting drug-free alternatives as the primary treatment for musculoskeletal pain.

Research on Early Physical Therapy and Opioid Use

Does early physical therapy influence opioid consumption? Recent studies indicate that early physical therapy for lower back pain may lead to a reduction in opioid use. However, there is limited research examining similar effects on other types of musculoskeletal pain. A research team from the United States aimed to investigate the impact of early physical therapy on opioid use in light of the ongoing opioid epidemic and published their findings in JAMA Network Open.

Study Methodology

The authors of the study analyzed insurance claims data from the IBM MarketScan Commercial database, covering the years 2007 to 2015. This dataset included anonymized patient-level diagnosis and drug information. Approximately 90,000 adults with musculoskeletal pain in specific regions of the body were identified as eligible for the study, with an average age of 46. Notably, 29% of these patients received early physical therapy within 90 days of their diagnosis.

Findings on Opioid Use Reduction

The study revealed that patients who underwent early physical therapy were typically younger and more likely to be female. Researchers focused on opioid use between 91 and 365 days post-diagnosis. Statistical analyses indicated that early physical therapy was associated with a 10% reduction in long-term opioid use among patients experiencing neck pain, shoulder pain, lower back pain, or knee pain. Further analysis showed that patients receiving physical therapy within 30 days of diagnosis had an even lower likelihood of opioid use for neck, shoulder, and lower back pain.

Conclusion and Implications

This study highlights the benefits of early physical therapy across various types of musculoskeletal pain, demonstrating a significant reduction in long-term opioid use for patients who engaged in early treatment. Recent clinical guidelines now recommend physical therapy as a first-line approach for managing musculoskeletal pain, a recommendation supported by the findings of this study. Increased scientific evidence favoring opioid-free pain management strategies may contribute to diminishing the misuse and abuse of opioids.

Author and Reference

Written by Branson Chen, BHSc
Reference: Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Network Open. 2018 Dec 7;1(8):e185909-.