This country’s opioid crisis is a hot topic in healthcare. Because of the national attention the issue is garnering, physicians are feeling the pressure to reduce prescriptions for these drugs. Fortunately, there is a better avenue.

Physical therapy can be just that—long-term relief from pain without medication.

Rehab Director Skylar Tarbet, PT heads our outpatient clinic in South Bend, Washington. We asked Skylar about the issue.

Are you identifying patients as they come in who have addiction? Or are you just combating it by educating on pain management without the use of opioids?

The majority of people I bring it up with have chronic pain. They typically have some kind of dependency on opioids or have in the past. In Washington, there has been a big push to reduce dependency so people are getting cut back on their meds and doctors are looking for alternate ways to manage their pain.

So, what do you do? 

A good chunk of it is education—just trying to tell them a little bit about the anatomy and physiology of pain and why we hurt versus only focusing patient education on the mechanical/structural component or original cause of the pain. For example, only talking about a patient’s spinal disc herniation in relation to pain can actually elevate fear avoidance behaviors.

Pain is much more complex than “I hurt here and I take a pill for that.” Pain is not produced at the tissue or joint level within our body, but rather pain is produced in the brain by perception of threat. When we perceive something to be a threat, our body sends impulses to the brain that is interpreted as pain. In an acute situation, this is a legitimate response and the body will avoid further exposure to this stimulus. Over time, we learn to avoid the threat out of fear of pain, which then creates increased sensitivity of our pain receptors. When this vicious cycle exists longer than six weeks to three months, we consider it chronic pain. With chronic pain, the tissue has had enough time to recover, but the brain has learned a conditioned response to interpret certain movement as “painful,” which leads to long-term disuse. The pain is no longer informative about what’s really occurring in our body. The brain has become hypersensitive. Patients come in and show an x-ray or MRI and say, “Look here I’ve got a bulging disc or structural problem causing pain.” Most of the time it’s no longer a structural issue; the brain has become sensitized to interpreting every signal from that part of the body as pain, even though no further damage is happening.

So, it’s a perception thing?

It’s a body/mind retraining really. We must teach the brain that it’s okay to move. Patients need to understand that first.  Normal movement will not cause more tissue damage. We need to re-condition the brain to interpret normal movement patterns while educating the patient on their tolerable pain levels.

I recently had a patient who could barely walk or stand up. He was in excruciating pain. I sent him home with exercises and education. He was proactive in making life changes seeking education regarding his problem, and at his last appointment he was a completely different person. He still has perceived pain with movement, but he is relearning how to move and managing his symptoms.

Our approach to patients with chronic pain has got to be a one-on-one experience. We must assist each in finding the movement/mobility they previously had through quality education and movement training.