Chronic Pain: Implementing A Physical Therapy Plan

Dr. Laura Stewart

Lady with back pain

Chronic pain is one of the leading reasons many people become addicted to opioids. According to the National Institute on Drug Abuse, 21 to 29 percent of people who were prescribed opioids for chronic pain abused those drugs. The prevalence of patients with chronic pain who were abusing opioids, means that, a key way to address this crisis is to find other ways to help patients deal with chronic pain.

One of the ways to address this type of substance abuse is to implement a physical therapy component to a patient’s treatment plan. Treating opioid addiction with the mind and body approach can help the patient recover from both a psychological and a physical perspective – both of which contribute to the underlying physical pain that leads to opioid addiction. It is important to note that understanding the role of the brain and body connection does not imply chronic pain is not real, or is “all in the head”. This pain is indeed very real, and what we now know about chronic pain, is that it is also very complicated. This type of complicated pain is best treated with a biopsychosocial model which should include exercise and physical therapy.

Here are a few benefits to implementing physical therapy into a recovery treatment plan:

Breaking a Mental Hurdle

One of the hardest parts of dealing with chronic pain is teaching a patient that they can move again without the use of opioids. Implementing a physical therapy program during recovery seeks to counter that protective thinking by training the brain that it can move, and it is safe to move without painkillers.

Physical therapy can give the patient a powerful tool from a neurochemical perspective because it creates structured activity to create dopamine in the brain. A program that creates natural dopamine is important because a recovering patient’s neurochemical baseline has been altered, and is vulnerable to relapse.

A physical therapy program shows the patient if they keep moving, the brain grabs on to the good feeling of natural exercise. By showing the patient they can create dopamine through physical fitness, it creates a purpose and structure that the patient didn’t know they could have. This structure makes it less likely the patient will relapse, because they will not have the crutch of a synthetic opioid.

A Plan to Bridge the Gap 

Anyone in recovery for opioids due to chronic pain, knows it is important to get moving. They understand that they should walk or stretch, but the hurdle is getting the patient from knowing they should do something, to actively doing it.

A physical therapy program can bridge that gap by slowly integrating activity into a recovering patient’s day.

A physical therapist knows where the patient’s chronic pain level is at, and can work with the patient’s doctor to craft a plan that takes into account their medical history and their ability to move. This could mean that a recovering patient’s plan might only consist of light stretching or rigorous cardio.

Having a physical therapist, along with the behavioral health specialists at your disposal, can help patients even more, because together, they can create a treatment plan that balances a safe level of physical activity with the medical help they need.

The point of physical therapy, when it comes to chronic pain and opioid addiction, is to get the patient moving; and letting the patient know that moving will not hurt them. The benefits of exercise and physical therapy don’t need to require vigorous movement, in fact, even your basic yoga exercises can help alleviate some chronic pain.

A study published in the Annals of Internal Medicine found that 313 people with chronic low back pain reported more mobility after a weekly yoga class. This increased mobility was in comparison to standard medical care for chronic back pain.

Another study by the American Pain Society showed that yoga and chronic pain have the opposite effects on the brain’s gray matter. This means that while chronic pain causes deterioration of gray matter in the brain, forms of physical therapy such as yoga, can hinder gray matter deterioration.

These two studies show that even simple exercises can benefit recovering patients by helping them alleviate chronic pain without the use of pain-numbing drugs.

Creating Opioid Free Pain Management

Addressing how to treat the opioid epidemic is one of the most important health challenges of our time. Despite positive steps in legislation, we are still figuring out the best way to move away from many medication-based treatments to treatment alternatives that treat chronic pain, but do not use opioids.

Physical therapy is becoming one of the safest and most effective alternatives to pain management.

The Center for Disease Control has even stated that non-opioid therapy such as physical therapy was the preferred method of treatment. More and more health professionals are promoting physical therapy. Patients also agree that any new form of pain management treatment should also be opioid free.

According to a Gallup poll ,78 percent of respondents preferred to try other ways to treat pain management before being put on opioid treatment. This means that patients are more than willing to try alternative drug free treatments, and treatment centers should make programs like physical therapy readily available.

This patient demand, along with other clinical professionals, means physical therapy is a good alternative treatment, and could be one of our most helpful tools to reducing opioids vast place in treating pain management.

Eliminating opioid addiction is a battle we have to fight in creative ways. Acute pain treatments, such as physical therapy, will play a key role in winning that battle. Physical therapy creates a way to show patients that they can move without opioids, and their chronic pain can be managed long term. Physical therapy breaks one of the biggest hurdles to beating addiction for chronic pain users, and that hurdle is getting patients to move long term.

Physical therapy can not be the only aspect of a treatment plan, but implementing a physical therapy program can have a lot of long-term benefits for patients. Physical therapy should be available in more treatment centers nationwide.

Dr. Laura Stewart is the Executive Director of Recovia a functional chronic pain opioid detox program in Arizona. Dr. Stewart has a Doctorate in Clinical Psychology. Her training was focused on the Neurobiology of PTSD and addiction.