The workers’ compensation system was among the first groups to identify and target opioid abuse among patients with chronic pain. Because workers’ compensation is administered on the state level, many legislative initiatives have been implemented within various states. One that has gained increasing attention of late is the use of prescription drug monitoring programs, or PDMPs.

Nearly every state has a program that tracks medications purchased by patients, regardless of the healthcare system involved. The programs have differing names depending on the jurisdiction, but the overreaching idea is to allow for monitoring of prescriptions in an effort to prevent overuse or abuse of medications. Some programs allow the information from their databases to be viewed by pharmacies and other authorized personnel in other jurisdictions — again, to prevent doctor shopping and other methods of attaining an overabundance of medications.

Physicians are among those authorized to access the databases so they can monitor the medications their patients have purchased before overprescribing them. In some jurisdictions, physicians are actually required to access the programs. That requirement resulted in a significant decrease in the rate of opioid deaths and misuse in Kentucky, according to a recent blog post.

In addition to PDMPs and laws to reduce the strength and/or days of opioid prescriptions allowed, governments and healthcare providers have increasingly examined non-pharmaceutical methods to treat patients in pain. Physical therapy has been shown to be among the most viable.

How PT Works

Physical therapists use a variety of tools to treat people in pain. Because of our education and training, we are able to identify the needs of each specific individual and develop the most effective treatment options. There are several ways we do this.

Movement. This is key to reducing pain, and it is how physical therapists treat the problem. Research has shown that people who exercise on a regular basis have less pain than sedentary individuals, especially those who exercise at least 3 times per week. 

Injured workers are, understandably, often fearful of improper movements and exercises that exacerbate their pain or, worse, result in even more injury. Physical therapists who take the time to work closely with them can determine what exercises and movements are most appropriate and how they should be executed.

Having an ongoing one-on-one relationship with the injured worker allows the therapist to adjust the types and intensity of the exercises as the person is doing them. Therapists who work with injured workers at the actual worksite are in the unique position of being able to see exactly what tasks need to be done and can then guide the injured worker to do them in a way that helps restore function, rather than causing additional pain or injuries.

Hands-on treatment. Manipulation, joint or soft tissue mobilizations and dry needling are among the treatments highly trained physical therapists use to reduce pain. As the name suggests, it is done with the hands rather than a device.

Manual physical therapy is a specialized form of physical therapy and should be used in conjunction with movement and exercises. The idea is to put gentle pressure on muscle tissue and decrease pain caused by spasms, tension or joint dysfunction.

Depending on the injured worker’s specific injury and needs, the physical therapist may use muscle energy techniques; strain/counterstrain, where the therapist guides the patient’s body and muscles into a position to decrease spasms; and myofascial release, which is especially helpful when an injured worker cannot identify where the sore spots are.

Education. Understanding helps bring relief, and that is especially true of pain. Injured workers who are informed about where and why their pain exists and have realistic expectations about the treatment typically fare much better than those who are not fully engaged in their treatment.

In addition to the pain surrounding the current injury, it’s important to understand the injured worker’s pain history. A competent physical therapist spends time with the injured worker to identify current and previous pain, as well as any comorbid conditions that might be present.

Physical therapists are also able to educate their patients on lifestyle choices, such as nutrition.

Trust. It’s vitally important that the injured worker have a trusting relationship with any medical provider involved in his recovery. Recovering from injuries involves a two-way street and injured workers who work with and rely on their providers stand a much better chance of returning to function and work sooner than those who do not.

Why PT

As part of its campaign to encourage PT as a treatment to prevent opioid abuse for pain, the American Physical Therapy Association compared the side effects of opioids and those with PT.

Opioid side effects: Depression, overdose, addiction, withdrawal symptoms. Additionally, there is inconclusive research indicating the effectiveness of opioids to treat chronic pain.

PT side effects: Improved mobility, increased independence, decreased pain, prevention of additional health problems (through exercise and movement). The Centers for Disease Control and Prevention also said there is “high quality evidence” that PT — especially exercise, helps low back pain, as well as hip and knee osteoarthritis. In fact, there is growing evidence showing that PT is as effective as surgery for certain conditions, such as rotator cuff and meniscal tears.

Opioids have a place in the treatment of pain for a small percentage of patients. However, the gross overuse of the medications points to the need to try other remedies first. Helping injured workers in pain through PT can prevent many from the ravages of unnecessary opioid use. Find out how PhysNet’s one-on-one, at-work PT treatments can help your injured workers.