Early physiotherapy reduces the need for opioids in pain management

Patients with severe musculoskeletal pain benefit from early physiotherapy. According to a recent study, up to 10% fewer opioids were needed after 9 months of physiotherapy.

The addictive potential of opioids should not be underestimated

Patients with severe musculoskeletal pain benefit from early physiotherapy. According to a recent study, up to 10% fewer opioids were needed after 9 months of physiotherapy.

The excessive prescription of opioids in the USA has reached epidemic proportions. Many Americans are already considered opioid addicts. This makes it extremely important to look more closely at non-pharmacological alternatives in pain medicine. As a rule, opioids should be used for as short a time as possible. A recent study has looked into the role of physiotherapy in patients with muscle, joint and skeletal pain.

Study shows a decrease in opioid use

In total, data from 88,985 opioid-naïve privately insured people aged between 18 and 64 were included in the study. All patients had had to deal with musculoskeletal pain in the shoulders, neck, knees or back between 2008 and 2014.

However, only those patients who complained of severe pain were looked at in greater detail. In these patients, the diagnosis had to be confirmed within 30 days and an opioid had to be prescribed within 90 days. The study then investigated the influence of physiotherapy on opioid use in these patients.

In total, about one-third of the patients (29.3%) received early physiotherapy. As a result, they also showed a significant decrease in opioid consumption compared to the pain patients without accompanying physiotherapeutic measures.

Opioid use (measured in milligram morphine equivalents or MME) in physiotherapy decreased by up to 10% across all groups. In detail, it decreased by -9.7% for shoulder pain (p=0.03), by -10.3% for patients with knee pain (p=0.07) and by -5.1% for lumbar pain (p=0.046). However, patients with neck pain (-3.8%) did not benefit from early physiotherapy in terms of lower opioid intake (p=0.30).

What does this imply for pain management and physiotherapy options?

In practice, early physiotherapy could help patients with musculoskeletal pain to relieve pain symptoms and even save money on pain medication. Although a reduction of about 10% in drug intake does not seem to be particularly high, a reduction of doses in everyday life is not without relevance for the patients, especially in view of the addictive potential of opioids. As a replacement for medication, physiotherapy proved successful for patients with musculoskeletal complaints.

Original study: 
Sun E et al., Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open 2018;1(8):e185909

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