Let’s take a look back to how we got here. The “pain as the 5th vital sign” started in 1996 due to people with chronic pain not receiving adequate care. I know this may sound shocking, but the campaign was written with the help of pharmaceutical companies (more than a dozen that produced pain relievers.) And the prescribing of opiates began to increase, as did the American intolerance for discomfort.
Doctors were taught, as was I in PT school, that “opioids are not addictive if you are actually in significant pain.” I remember being told that people would not get addicted if they only took the medication when they were in real pain – it was taking it when they weren’t in a high level of pain that would lead them into addiction, and therefore if pain medication helped tolerate physical therapy, then patients should actually be encouraged to medicate for the session. This theory stemmed from a 1986 study with only 38 subjects that determined low-dose pain medication maintenance therapy was safe. This clearly does not translate into safe opiate use or addiction rates, nor should it be considered applicable to today’s extended-release synthetic opioids.
We need to educate physicians about our level of expertise and what treatments may consist of to treat pain. Many do not give their patients the option of physical therapy. The door is open for us to get them to think of PT any time a patient is asking for a narcotic prescription. Physicians can write this referral as quickly as the prescription, as long as they are confident in the results.
As mentioned, educating people in pain about what could be contributing to the pain, and how PT treatment will help gives a sense of control. Incorporating education about the side effects of pain medication may be helpful in keeping your clients focused on the long term goal. Many of them may also be on multiple medications to address the side effects of opiates, which in turn have side effects of their own. Patients rarely give thought to how these chemical are filtered, and what they may be doing to their liver or kidneys. Again, knowledge helps to give a sense of control. Educate your patients.
Again, here is the MoveForward PT ad to share with everyone: https://youtu.be/RWpnMsAjX5k