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Life beyond opioids - How physical therapy is changing the game for chronic pain patients

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Added on October 2, 2018

The opioid epidemic has been big news. No one wants to live in constant pain, but many people also don't want to face the risks associated with opioid painkillers. Opioids are highly addictive and can lead to depression, overdose and withdrawal symptoms – stealing one's quality of life and destroying relationships in the process. 

While opioids are appropriate in certain situations, they usually are not the best first course of action. Twenty-five years ago, it was common practice for physicians to prescribe opioids for pain, especially for chronic health conditions or ongoing pain. Both the Centers for Disease Control and Prevention and American Medical Association have changed their stance, recommending non-opioid therapy and lower dosages to reduce the risks of opioid use disorder, addiction and overdose.

Physical therapy first over opioids

For many patients, physical therapy provides a safe, longer-lasting alternative to masking the pain with opiates. Lucas Briggs, DPT, CSCS is a physical therapist with Ivy Rehab Network partner clinic Grand Rapids Performance Center in Grand Rapids, Michigan. Lucas is an expert at treating patients with chronic pain related to sports injuries, fibromyalgia, and other widespread musculoskeletal pain. 

"It's not like a whole lot of medical providers were trying to do wrong, those were the guidelines for a long time," he said of the previous prescribing practices. "A lot of physical therapists weren't as well equipped (to treat pain) until recently. We have learned so much about pain science in the last 15-20 years."

Many of his patients have come to work with him after long-term use of opioids to manage their pain with little to no success. Lucas shared the story of his patient Sarah, who was prescribed opiates for more than 20 years as the long-term solution to combat her back pain. 

"The most evidence-based intervention for pain is to get patients on some nerve membrane stabilizers and then get them to a specialized physical therapist," he said. "The other part that can be relevant is getting people to counseling when appropriate."

Sarah's story with opioids

A normal gal with a bit of a rough childhood, Sarah was funny, athletic and healthy. She played sports, had friends, worked and lived a relatively normal life until the burdens became too much to hide away. At 17 years old, Sarah had a child that she gave up for adoption. 

Sarah shared a lot of her childhood trauma during her physical therapy sessions. Lucas learned she harbored painful emotions from sexual and verbal abuse, workplace issues, and from giving her child up for adoption. 

Lucas said the physical trauma of childbirth "likely started the cascade of movement patterns and imbalances that led to her talking with her doctor about her back pain." 

"Having chronic pain goes way up if you've had an adverse childhood experience (ACE)," he said. "The reason for that is if you don't have the cognitive ability to recognize this trauma is not going to repeat itself over and over again, your body just stays on alert." During their sessions, Lucas encouraged Sarah to see a counselor to deal with the underlying emotional issues contributing to her pain.

The truth about opioid "painkillers" and chronic pain

As was common 25 years ago, Sarah was prescribed opiates. "They were called 'painkillers', so Sarah knew what they would do," Lucas said. But her back pain kept getting worse and worse with each year, culminating in an L5/S1 fusion and over two years of being homebound with pain. 

"A year after back surgery, she sat in a chair thinking it would get better," he said. "Her pain wasn't getting any better, so she called up her doctor and he sent her to us."

Changing the game and the way we play

Sarah's new medical team changed the game for her. A new physician helped her better manage her medications, and Lucas has worked with her on recognizing and calming her physical triggers. As traumatic emotion triggers began to emerge, Sarah began counseling with recommendations from Lucas and her doctor. 

Lucas explained the science of pain, how opiates could actually increase her pain over time as opposed to decreasing, as well as lead to physiological addiction. Working with Lucas over the last several months, Sarah has learned how to manage her nervous system, how to relax, and how to move better. That's involved changing the way she breathes, sits, stands, walks, the way she paces herself with her daily activities, and taking meaningful rests to declutter her brain.

"People are in chronic pain (if it's not just a poorly managed orthopedic issue) because their nervous system is on alert and they don't know how to quiet down," he said.

Recovery and a new life for Sarah after opioids

Lucas is happy to report that with the guidance of her doctor, physical therapy, and counseling, Sarah, now in her 40s, has been able to wean off opiates completely, reduce her pain significantly, lose 40 pounds, and regain her life. 

"She wanted a change and that's where her attitude made all the difference," he said. "She came in wanting to get off medication, wanting to get better, wanting to get her life back."

While every patient is unique, there are some commonalities among patients who report chronic or widespread pain. Neuroscience research has found that "so much of pain is in your brain and how the brain changes with persistent pain," Lucas said. Often, people with childhood trauma, chronic stress or depression and anxiety, are more susceptible to experience severe and long-lasting pain. They are hypersensitive to pain impulses because they are mediated by the same three areas of the brain.

Physical therapists can help chronic pain patients

Physical therapists are really well-equipped to teach people about the physical ramifications of pain. In therapy, Lucas teaches patients about the neuroscience behind pain: how words, pictures, and feelings can affect pain along with the physical component. He will sometimes show patients this by letting them experience how a word or phrase itself can increase discomfort or pain.

"We can figure out what triggers your pain alarm and it's not just physical movement," he said. "If somebody is fearful of bending forward because it causes pain, you can ask them to envision bending forward. That can be a useful exercise or that can flare them up."

"What they have found is that when a lot of little things add up, pain can really spiral," Lucas continued. "Opiates will end up making your pain receptors hypersensitive over time so you'll end up getting more pain."

Connecting to the body through exercise and mindfulness

Besides learning useful exercises and stress-reduction techniques in physical therapy, a shift in mindset can also do wonders in a patient's outcome. After 20 years, Sarah reported the mental fog she had experienced has lifted and she feels like she is truly living again. She had a lot of issues connecting with her body because it had been 20 years of medicating it and not listening to it.

"Opiates numb you to your body, you just kind of disconnect from everything," Lucas said. "It's reconnecting with your body through your everyday lifestyle, where you're not guarding and tightening up all the time, that really makes a huge difference for our patients." 

October is National Physical Therapy Month. If you're tired of living with chronic pain or masking it with medication, contact your local Ivy Rehab Network clinic for more information on unique and alternative therapies that can help you alleviate pain or learn to manage it. Managing your chronic pain with physical therapy can lead to a more productive and joyful life. 

 

 

 

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