Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain

Sun, Eric; Moshfegh, Jasmin; Rishel, Chris A; Cook, Chad; Goode, Adam P.; George, Steven Z.

doi:10.1001/jamanetworkopen.2018.5909

Cited by 86 publications

(57 citation statements)

References 31 publications

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“…[12][13][14] In the primary care setting, early physical therapy (PT) appears to be associated with lower utilization of advanced imaging, lower rates of lumbar spinal injections and lumbar spinal surgery, and improved patient satisfaction. [15][16][17][18][19] In the ED, a primary contact physical therapy model has been shown to reduce wait times and improve patient flow, directing patients to early effective care, and freeing emergency physicians to focus on other emergent cases. [20][21][22][23][24] A primary contact model involves the Physical Therapist acting as primary provider and autonomous practitioner.…”

Section: Introductionmentioning

confidence: 99%

Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

et al. 2020

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Background Emergency department based Physical Therapy (ED-PT) has been practiced globally in various forms for over 20 years and is an emerging resource in the US. While there is a growing body of evidence suggesting that ED-PT has a positive effect on a number of clinical and operational outcomes in patients presenting with musculoskeletal (MSK) pain, there are few published narratives that quantify this in the US. Although there are international papers that offer outcome data on reduction of pain, imaging, throughput time, and the ability of physical therapists to appropriately manage MSK conditions in the ED setting, most papers to date have been descriptive in nature. The purpose of this study is to assess the impact of ED-PT on imaging studies obtained, rates of opioids prescribed, and ED length of stay. Methods We prospectively identified patients presenting with musculoskeletal pain to an urban academic ED in Salt Lake City between January 2017 and June 2018. During the study, a physical therapist was in the ED three days (24 hours) per week and was available to evaluate and treat patients after consultation by the ED provider. We noted patient demographic information, imaging performed in the ED, medications administered and prescribed, and ED length of stay. We classified patients as those who received PT in the ED and those who did not and compared clinical outcomes between groups. We performed a subgroup analysis of patients presenting with low back pain and matched patients by age and gender. Results Over the 18-month study period, we identified 524 patients presenting to the ED with musculoskeletal pain. 381 (72.7%) received ED-initiated PT. The PT and non-PT groups were similar in average age (42.8 years vs. 45.1 years, p = 0.155), gender (% female: 53% vs. 46.9%, p-0.209), and primary presenting chief complaint (cervical, thoracic, or lumbar pain:

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Section: Introductionmentioning

confidence: 99%

Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

et al. 2020

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“…One study showed that early physical therapy for neck pain may decrease total treatment costs and the use of prescription medicines, including opioids [45]. The authors of another study reported that early physical therapy may reduce both the frequency and level of opioid use for all of the musculoskeletal pain regions [46]. The conclusion to be drawn here is that early physical therapy or exercise therapy may be a good option to reduce the use of opioids and/or other analgesics when the pain level remains low.…”

Section: Discussionmentioning

confidence: 99%

Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain

et al. 2020

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Introduction: Neck pain is a common condition that leads to serious pain, disability, and increased healthcare costs worldwide. Pharmacotherapy is one of the most common strategies to reduce neck pain in patients. The aim of this study was to analyze the real-world pattern of drugs prescribed for patients with neck pain in the USA. Methods: Data on individuals who reported current neck pain in the 2009-2010 US National Health and Nutrition Examination Survey (NHANES) and with a history of persistent pain for at least 6 weeks or 3 months were extracted from the NHANES database. Those included in the study were divided into three groups based on the duration of pain: the without neck pain group (Group A); subacute group (Group B) with a history of 6 weeks of neck pain; and the chronic neck pain group (Group C) with a history of 3 months of neck pain. The use and duration of medication Digital Features To view digital features for this article go to

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“…28 A cross-sectional analysis of US health insurance claims data from 2007 to 2017 linked early physical therapy to an approximately 10% statistically significant reduction in oral morphine milligram equivalent (MME) use for LBP (p=0.046), shoulder pain (p=0.03), and knee pain (p=0.007) in adults with no previous opioid prescriptions. 29 Although generally considered beneficial, with studies supporting minimal to moderate improvement in CLBP, the effectiveness of physical rehabilitation has not been well supported by systematic reviews. For example, 2011 and 2018 reviews concluded that there was insufficient data to support these interventions due to the heterogeneity of patients and interventions.…”

Section: Pros and Cons Of Nonpharmacologic Therapiesmentioning

confidence: 99%

<p>Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development</p>

Gudin¹,

Kaufman²,

Datta³

2020

JPR

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The continued prevalence of chronic low back pain (CLBP) is a testament to our lack of understanding of the potential causes, leading to significant treatment challenges. CLBP is the leading cause of years lived with disability and the fifth leading cause of disability-adjusted life-years. No single non-pharmacologic, pharmacologic, or interventional therapy has proven effective as treatment for the majority of patients with CLBP. Although non-pharmacologic therapies are generally helpful, they are often ineffective as monotherapy and many patients lack adequate access to these treatments. Noninvasive treatment measures supported by evidence include physical and chiropractic therapy, yoga, acupuncture, and non-opioid and opioid pharmacologic therapy; data suggest a moderate benefit, at most, for any of these therapies. Until our understanding of the pathophysiology and treatment of CLBP advances, clinicians must continue to utilize rational multimodal treatment protocols. Recent Centers for Disease Control and Prevention guidelines for opioid prescribing recommend that opioids not be utilized as first-line therapy and to limit the doses when possible for fear of bothersome or dangerous adverse effects. In combination with the current opioid crisis, this has caused providers to minimize or eliminate opioid therapy when treating patients with chronic pain, leaving many patients suffering despite optimal nonopioid therapies. Therefore, there remains an unmet need for effective and tolerable opioid receptor agonists for the treatment of CLBP with improved safety properties over legacy opioids. There are several such agents in development, including opioids and other agents with novel mechanisms of action. This review critiques non-pharmacologic and pharmacologic treatment modalities for CLBP and examines the potential of novel opioids and other analgesics that may be a useful addition to the treatment options for patients with chronic pain.

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Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain

Cited by 86 publications

References 31 publications

Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain

<p>Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development</p>

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