Alternative Therapies to Opioids

Friday October 16, 2020

Alternative Therapies to Opioids

The Opioid overdose epidemic has been recognized as a public health crisis in the United States with devastating consequences including, an annual death toll of 67,212 in 2018, massive cost to healthcare, lost productivity, and criminal justice involvement.  The coronavirus pandemic has had a negative impact on the work that has been done with the opioid issue.  According to the CDC National Center for Health Statistics July 2020 monthly report the drug overdose death count has not improved, with the COVID-19 pandemic.  There is a 4.8% increase in drug overdose deaths over the last 12 months.  This article published in the June issue of The American Journal of Managed Care speaks to the escalation of the opioid epidemic due to COVID-19.   

The arrival of the coronavirus disease 2019 (COVID-19) pandemic has provided an unanticipated haven for the already formidable opioid epidemic. COVID-19–related protective shelter-in-place orders have pushed individuals battling sobriety into isolation and have decreased access to treatment and opportunity for distraction from addictions.  …..If social distancing bolsters the opioid epidemic, the opposite behaviors strengthen our attack on it: emotional resiliency building, stress reduction techniques, health education, facilitated human connection via group treatment (when epidemiologically safe), abundant access to classic opioid alternatives like buprenorphine, integrated interdisciplinary modalities, and promotion of appropriate and sustainable physical activity.  

Another recent article in the Washington Post found that suspected overdoses for all drugs, not just opioids, jumped 18 percent in March 2020 compared with last year. 

Social distancing has also sequestered people, leaving them to take drugs alone and making it less likely that someone else will be there to call 911 or to administer the lifesaving overdose antidote naloxone, also known as Narcan. 

Making matters worse, many treatment centers, drug courts and recovery programs have been forced to close or significantly scale back during shutdowns. With plunging revenue for services and little financial relief from the government, some now teeter on the brink of financial collapse

The Centers for Disease Control (CDC) released opioid prescription guidelines recognizing that opioids are appropriate in certain cases such as cancer treatment, palliative care, end-of-life care, and in certain acute care situations – if properly dosed. But for other pain management, the CDC recommends non-opioid alternatives such as Physical Therapy  and Massage Therapy to cope with chronic pain. 

Physical therapy is a dynamic profession with an established theoretical and scientific basis for therapeutic interventions. Physical therapists work both independently and as members of multidisciplinary health care teams to enhance the health, well-being, and quality of life of their patients. PT has been shown to be effective at controlling pain and decreasing opioid use by increasing muscular strength through therapeutic exercise. Studies have shown that there is a direct association between increased muscular strength and decreased pain. Similarly, and equally important, exercise can decrease an individual’s perception of pain

 

Massage Therapy is a part of the multidisciplinary team to help with pain management. Massage therapy is a safe option that has been shown to be effective for many health issues.  

Research continues to support the health benefits of massage therapy for pain relief with low-back pain, fibromyalgia, post-operative pain, cancer patients, and arthritis.  The American Massage therapy association has more information on each of these research based conditions here.  

 

There is currently a growing support for a new piece of federal legislation that can help with opioid addiction in America. The Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 5172/S. 3067) is a bipartisan piece of federal legislation. The bill addresses reimbursement policies to increase the utilization of non-opioid pain management approaches for the tens of millions of Americans who undergo an outpatient surgical procedure every year.  

The NOPAIN Act defines a “non-opioid treatment” as drugs, biologicals, or medical devices that have demonstrated the ability to replace or reduce opioid consumption in a clinical trial or through clinical data published in a peer-reviewed journal. Additionally, the NOPAIN Act requires a report to Congress on limitations, gaps, barriers to access, or deficits in Medicare coverage or reimbursement for therapeutic services (e.g. acupuncture, chiropractic services, psychological services, therapeutic massage, etc.) and recommendations for Congress or CMS to address any limitations identified. 

And finally, patients with chronic pain should be encouraged to take an active role in their recovery. Research has shown that patients who advocate for themselves and collaborate on their care enjoy better outcomes.  While it can be difficult to stay active when experiencing pain, patients should consider consulting a movement professional, such as a Physical Therapist, to find ways that they can get moving safely and without increasing pain. 

The bottom line is that the opioid epidemic is a complex problem that will be solved only through multidisciplinary collaboration, and that individuals with chronic pain must be offered interventions that not only control pain but also address the causes of pain. The CDC and other major health agencies and organizations all have affirmed that nonpharmacological and nonopioid therapy can be effective in managing chronic pain.