I often think of myself as a “connector” in the profession of physical therapy and within my community. In the role of a connector, I get to talk with PT students, mentor residents and fellows in training, advise practice directors and owners, serve on the Board of my state association and participate in the Department of Health’s opioid work group within my state. One of the over arching questions or themes that comes up over and over is what is the role of the physical therapist in the opioid/pain epidemic? Students and clinicians often feel ill-equipped and under supported to treat patients in pain. Practice owners see the potential market for their business, but often are not sure what the next steps are to transform their practice to treat pain. The larger medical community fails to recognize the role of PT in managing the opioid epidemic and continues to look at this problem from a pharmacological perspective.
It is imperative to know that the chronic pain epidemic is not a United States (US) issue, but rather a global concern. What is unique in the US, however, is the opioid epidemic. We now know that 99% of the world’s use of hydrocodone is being consumed by Americans and annually three times more people die from prescription opioids than heroin and cocaine combined! Today alone, 72 Americans will die from prescription opioids. In lieu of this epidemic, the American Physical Therapy Association (APTA) has launched its campaign #ChoosePT. This campaign is
a nice start, but lacks the direction and marketing zeal of the pharmaceutical companies to truly grab societies attention. Who is the APTA? So often I hear about therapists who find little value in the APTA or are “mad” at the APTA for not supporting a cause, not representing the profession (you) a certain way, etc. Have you forgotten? YOU/WE are the APTA and the APTA can only be as strong as its membership. With the “new” opioid epidemic so many are looking at the APTA for help, guidance and “the magic answer.” Well, find a mirror and ask yourself a question: “If I’m so good, then why are my patients so bad?”
For physical therapy to impact the US opioid epidemic, it will take more than a simple campaign like #ChoosePT, and yes we SHOULD look at the APTA – YOU. Sure, the leaders and researchers in our profession are exploring all new avenues, conducting large-scale studies, looking at healthcare utilization, clinical impact, etc.., but what about you? How can you be part of the pain revolution? I would argue one patient at a time. In the US there are almost 300,000 registered physical therapists and physical therapist assistants. If everyone developed a fundamental and working knowledge of pain sciences and helped patients, one at a time, with proven strategies, week in and week out, I fail to see how we cannot transform society. Pain sciences are the “hot new thing” and should not be seen as the “fix it,” but rather a piece of the puzzle. Current best-evidence strongly support the combination of cognitive therapy (for example, pain neuroscience education – PNE) plus movement as a means to help people with chronic pain. If we immerse PNE into compassion, empathy and a true interest in helping someone with pain, we develop a key part of the puzzle: TRUST and HOPE. If the movement component is tied into collaborative goal setting, pacing, graded exposure and creating independence, while weaving pain sciences into the realm of physical therapy and not merely psychotherapy, we will surely better help people in pain. The best part? You get to choose the movement component based on your expertise, background and area of interest. Mosely’s team has established the numbers needed to treat with this approach at 1:3 for improving pain and 1:2 for improving function. If you are not familiar with NNT statistics, this is more powerful than the best pharmaceuticals on the planet.
The late Dr. Patrick Wall, one of the most gifted pain scientists believed physical therapy is ideal to treat chronic pain for the following reasons:
- We have a larger work force
- We are movement specialists
- We utilize touch
- We spend time with patients
- We educate patients
- We have some exposure to psychology
- We are (for the most part) easily accessed
- We are cheap (when it comes to healthcare cost)
Just coming back from yet another invigorating CSM, I am happy to report the young generation is getting a handle on this “pain science” thing….or at least being updated on how pain works.
“Knowing pain,” however is not “Treating pain.” What is TRULY needed is a fundamental working knowledge of pain sciences – how to teach people about pain; how to pace education, exercise and daily activities, how to deal with setbacks, etc. Our team at the International Spine and Pain Institute, is launching an exciting campaign targeting APTA State Associations to help clinicians develop a clinically applicable, working knowledge of pain sciences, from the comfort of their homes. The best part? For each person signing up to learn about pain sciences, your State Association receives half of the proceeds, thus supporting your own Association.
So I ask not what APTA can do for the opioid epidemic, but what are YOU doing.
To learn more about ISPI’s Pain, PT and the Opioid Epidemic course please checkout the website here.
Contact firstname.lastname@example.org for resources and information regarding how to get your state involved.