Pain and Politics: Never Too Late to Get in the Game

I have a confession to make: I hate politics.  Well, maybe hate is a strong word, but generally, I speed past CNN, MSNBC and FOX News when channel surfing, avoid reading headlines in the checkout aisle, and I have pretty much said goodbye to Facebook.  My peace-keeping, Kumbaya, rose-colored-glasses-nature simply does not jive well with the conflict and contempt that often surrounds politics and current events. In fact, I am quite certain that if I had a chronic pain issue myself, it would have been severely exacerbated this past year with the palpable political tension in our beloved country.

This aversion to politics, coupled with a busy personal schedule, has spilled over into my responsibilities not only as a citizen, but also as a professional.  While I am a member of the APTA and am very proud of my Wisconsin PTA officers for their great work in making my state one of the friendliest states for PTs to practice in (we just secured X-ray ordering privileges!), my personal involvement there has been extremely limited.  Despite being a member for nearly 20 years, I am embarrassed to admit that I seldom attend even my regional meetings.

So, given the fact that I am, more often than not, a political-conversation-dodger who seems to breathe easier with my head in the sand, my recent visit to Washington D.C. to discuss the role of Pain Neuroscience Education (PNE) in Health Care Reform with my U.S. Senators’ offices was quite a surreal and unexpectedly uplifting experience for me.  I would never have even thought to go had it not been for a couple of brave and passionate colleagues of mine, Patty Benz, PT,  DPT, TPS and Colleen Louw, MPT, MEd, CSMT, TPS.  And I certainly wouldn’t have stepped so far out of my comfort zone if I didn’t believe, in the marrow of my bones, that our country needs us, as PTs specializing in the treatment of pain, to bring our expertise to the table.

I know I don’t need to preach to this choir.  Those of you reading this blog understand what our country is up against in terms of the opioid epidemic: 92 people die each and every day of an overdose, a great many of which slipped into their downward spiral following an experience with pain which never turned around.  Tim Flynn, in his excellent “Too Many Too Many’s” series is showing us just how out of hand this crisis has become.  And make no mistake (here is where I start to squirm)…there are BIG “powers that be” who have a lot to lose if conservative care (non-pharmacological, non-surgical, etc.) comes to the forefront in the treatment of pain.  But there comes a time when personal discomfort with politics and conflict needs to be set aside for the greater good.  And it took my courageous, hopeful friends and a trip to our nation’s capital for me to pop my avoidant, skeptical head out of the sand.

Once on Capitol Hill, my initial political apprehension was quickly put to rest as Colleen, Patty and I simply shared with our elected officials’ staff what we know to be true: pain and opioid addiction is a daunting problem, but we have something important to contribute to the solution.  For example, the current evidence supports the use of PNE for chronic musculoskeletal disorders in “reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization” (Louw et. al 2016).  In fact, data from Adriaan Louw et al.’s multi-center RCT on pre-operative PNE for lumbar discectomy is very compelling. According to the study, in the year following surgery, lumbar discectomy patients who learned HOW PAIN WORKS from a 30-minute, 1 on 1 pre-operative P.T. session using a $3.00 booklet spent, on average, $2,000 less in medical care than the control group, who underwent traditional biomedical education from the surgeon.  This cost savings held its ground over three years, with a 37% between-group difference in post-operative medical expenditures maintained over the years.  In addition, those patients who underwent PNE reported statistically significant differences in satisfaction with their surgery: overall, they were happier with their procedure.  If we apply these numbers only to discectomies (the population studied in the RCT), the potential for cost savings is phenomenal: 600,000 discectomies were performed in the U.S. in 2012.  At $2,000 less spent per case, this simple intervention could save our system $1.2 billion dollars in one year, and again, that is just discectomies.  I wonder what this would look like with patients undergoing fusions, which are performed on an even larger scale than discectomies.  This is language that can speak loudly to our elected officials.

As we shared our desire to be part of the solution with our respective Senators’ staff, we were encouraged by their responses.  Their interest was keen, and for some it seemed that interest was both on a personal and political level.  After all, whose life haven’t been touched by someone they love suffering from chronic pain?  They provided us with encouragement to continue our work in providing multidisciplinary continuing education to help all disciplines speak the same language when it comes to pain.  We left heartened, ready to more deeply explore ways that we can make a difference.

Since our trip, I have been examining the United States Department of Health and Human Services’ National Pain Strategy (thank you for sharing it with us, Larry Benz!).  I’ve noticed that the committee members invited to participate in the main conversations about pain consist primarily of physicians, nurses, educators, addiction specialists, psychologists and policy makers.  As a proponent of the bio-psycho-social model, I was encouraged to see psychologists on that list!  But I also realized that we have significant work to do to demonstrate that we too, as physical therapists, deserve a seat at the table.

While the APTA has done excellent work in preparing a position paper for us to share with our legislators regarding the opioid epidemic, I wonder how many PTs are even aware of the work our Association has done in this arena.  Am I the only one who was relatively ignorant of this?  I also wonder what else we as a profession can accomplish in regards to the pain and opioid epidemic as we edge into the political realm.

Which brings me to the title of this blog: It’s Never Too Late to Get in the Game.  Whether you are a political avoider like me, or you are an active participant in the Association (and THANK YOU if you are!), ask yourself, “What can I do to help make a difference in this epidemic?”  Is it time for you to get up to speed with Pain Neuroscience Education so you can give your patients the best, evidence-based care you can?  Is there a group you need to share your knowledge of PNE with, be it your peers, your community or your referral sources?  Is it time to get involved with your state chapter of the APTA or another group to build strength in numbers? Is there a letter you’d like to write to your government officials?

While I love how kind, caring and humble we generally are as PTs, I think the time is right for us to stand up and make some noise.  We CAN make a difference in our nation’s pain and opioid epidemic.  We just need to get in the game!  Looking forward to hearing your thoughts…


17 responses to “Pain and Politics: Never Too Late to Get in the Game

  1. Since opioid addiction rehab is largely about exchanging a destructive habit for a more positive one (like aerobic exercise and strength training),virtually any heretofore sedentary patient (addicted to opioids or not) who has completed a PT treatment series involving ther ex has, at the very least, started on making movement a regular part of their life. Those patients, it would seem, are prepared to begin a journey via movement, to overcome opioid dependency. How will PTs address this opportunity? A great reference is “Spark” by John Ratey, a Harvard psychiatrist. Read his work and some of you will begin to create great opportunities through partnering with behavioral health specialists like clinical psychologists and psychiatrists.

    1. Jessie Podolak says:

      That is a great point, James. Thank you for sharing. Looking forward to taking a look at “Spark!”
      Thank you!

  2. Kory Zimney says:

    Jessie, great to see you step and do some very important advocacy work. As our current APTA president Sharon Dunn likes to point out, “we are better together”. This principle stands strong on so many situations. But when we as the physical therapy profession stand up together for our patients in pushing for sound policy, we can transform society.

  3. Jessie Podolak says:

    Couldn’t agree more, Kory. We as a profession have so much to offer hurting people. We just need to make sure that the word is out to ALL who are touched by the opioid crisis, including those in positions to influence health care reform, etc. I love your phrase “transform society.” The culture surrounding pain has never needed transformation more than it does right now. Thanks for your insight!


  4. Nicholas Maiers says:

    Jessie, awesome post! I am thrilled to hear about the conversation that you, Patty and Colleen had and are having. You do such a great job articulating your perspective. I would love to see PTs in an even bigger role regarding policy and legislation. Lots of great work already done by the APTA but potential for much much more.

    1. Jessie Podolak says:

      Thanks, Nick! It would be great to see PTs intimately involved in the battle against opioid addiction on all levels, from patient care to public awareness, to advocacy for policy. There is great potential! Thanks for being part of the solution!


  5. Allyson says:

    My son has been a patient of Adriaan. He has a great success story. I am a nurse going back to school for my DNP. I plan on working with chronic pain patients. We would love to go help advocate in any way we can.

    1. Jessie Podolak says:

      Thank you for your comment, Allyson! Getting the word out about pain neuroscience education to ALL disciplines working with patients in pain is so important. What do you see being taught thus far in your DNP education as far as pain science?

  6. Renee says:

    Thanks for doing this & talking about it ! You inspire me ! Looking forward to meeting you this weekend in Vegas

    1. Jessie Podolak says:

      Hi Renee,

      It was great to meet you this weekend and hear your heart for advocacy. As we all do our part, we can keep getting past this big elephant, “one bite at a time.” Best wishes as you talk with the APTA!


  7. John Seip says:

    Jessie Thanks for this article! Not only does PNE save money pre-operatively but we have been using it in the acute care and I am seeing reduced lengths of stay, reduced re-admissions, and improved mobility starting in the ED with prevention of admission in the first place, to explaining pain to surgical patients, and even with cancer patients who are having flare of their chronic back pain. Thanks to the work you are doing MDs here in Duluth MN are now starting to have us see patients in the hospital to address their PAIN!! not just discharge planning.

    -John Seip

  8. Jessie Podolak says:

    Brilliant use of PNE, John! It would be awesome to study this trend formally. Any interest?? :-) Thanks for your comment and keep up the great work!

  9. Ina Diener says:

    Excellent, Jessie! I am inspiring influential physios in our country to also take on your mission! Keep up the good work!

  10. Lise McCarthy says:


    I thought I would post an invitation to all of you to reach out to your Physical Therapy State Advocate as a means to organize ideas and plans to educate others about PNE going forward. The PT State Advocate is the person who helps collect and disseminate information to/from your State and our national organization. For instance, pain research tells us that 80% of people with dementia have pain and that in this population pain is under-assessed so it is under-diagnosed and under-treated. In my State and many others, there were not any state courses offered in 2017 about how to manage pain in this population. So since these are my people, I am now organizing efforts to start change this in 2018, not just in my state but all states and US territories. I am doing this by working with the Academy of Geriatric Physical Therapy’s State Advocates and other interested PTs around the country. Maybe you don’t work with people with dementia but the approach of organizing as a professional is the same.

    We are stronger together! Wishing you all every success on your path as advocates for your patients and our profession!

    1. Jessie Podolak says:

      Thank you for this info, Lise! I couldn’t agree more—we are stronger together!

  11. P. Gainan says:

    I enjoyed your prospective on the ‘pain’ issue. I too have been not active with my local chapter. The squeaky wheel gets the grease. Our field , just like most others has to stand up and fight/lobby for the cause.

    1. Jessie Podolak says:

      Thanks for the comment! Since writing this post, I had the opportunity to attend my state PTA chapter’s PT Legislative Day in Madison, WI. I was pleasantly surprised by how much I enjoyed it and how rewarding it felt when the piece of propped legislation we were opposing was later knocked down. It really felt like our voice made a difference, and that I now had a more personal connection with those representing me for future issues. Also, they now have me as a resource and seemed quite appreciative of the visit. I encourage you to give it a try! :-).

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