An Alternative to Prescription Opioids

If you are paying attention to the news these days, you have heard about the “opioid epidemic.” Here in Vermont and nationwide, news of opioid addiction is everywhere. Perhaps you, a friend, or family member has been affected. If so, you know that addiction has many deeply troubling side effects, like depression, the loss of one’s job, fractured relationships, and a generally unsteady living situation. Moreover, those who are addicted are at high risk for overdose and death.

Many people who become addicted to opioids begin by taking prescription opioids in a way that seems safe. They may have had a significant injury. Their doctor prescribes codeine, Vicodin, or Demerol, for instance. They fill the prescription and take it as directed. Unfortunately, about 25 percent of people who use opioid prescriptions to manage pain become addicted.

According to the American Society of Addiction Medicine’s 2016 report on opioid addiction, 1.9 million Americans have a substance use disorder involving prescription pain relievers and 586,000 have a substance use disorder involving heroin, the street version of these powerful prescription pain medications. And overdose deaths have quadrupled since 1999. It’s enough to make anyone nervous about using a prescribed opioid.

There is good news, though. Medication is not the only way to treat pain. In March 2016, the Centers for Disease Control and Prevention released guidelines urging prescribers to reduce the use of opioids in favor of safer alternatives in the treatment of chronic pain. Physical therapy is one of the recommended non-opioid alternatives. But how does it work? Physical therapists treat pain in a number of ways. All of the ways together, help patients improve strength, flexibility, range of motion, and confidence.

The first one is by using manual therapy. Physical therapists may move your body for you (manipulation), apply gentle pressure or stretch the affected area (joint and soft tissue mobilization), and use a technique that resembles acupuncture (dry needling), for instance. From carpal tunnel syndrome to low back pain, research supports this hands-on approach to treating pain.

Physical therapists also educate patients about pain. For instance, pain feels as if it is emanating from the injured area, while in fact, pain comes from the brain. Simply understanding this is a big part of improving one’s reaction to pain. A therapist might also help a patient distinguish “good pain” from “bad pain.” Good pain helps the patient improve his or her capabilities and ultimately decrease pain. Bad pain causes further injury. Knowing the difference is a big part of recovering without the use of opioid medications, which simply mask the pain.

The third way physical therapists help patients who are trying to cope with pain without prescription drugs is by recommending and teaching exercise. You often hear that if the beneficial effects of exercise could be administered in a pill form it would be the most powerful drug available anywhere. And it’s true. Physical therapists prescribe specific exercises to each patient based on his or her unique needs and goals. They help patients develop a plan for regular exercise, which increases the body’s ability to cope with pain.

The fourth way physical therapists help is by being a teammate. They are positive and encouraging, and they help patients understand that their mindset and determination are among the most important pieces of their recovery. Participating actively in one’s own therapy builds confidence that relates to better long-term outcomes and increased quality of life.

Opioids do have an important role in health care, especially at the end of life. But so do other therapies that may work just as well or better without the risk of addiction. As your health care provider relates that he or she plans to write you a prescription for pain, ask if the medication is an opioid and whether there is an alternative.

To learn more, search #ChoosePT at This American Physical Therapy Association website provides informative articles, quizzes, and tools to help patients make a good decision about which pain management method to use.

Mark Epler, PT, DPT, CSCS, is a physical therapist at SVMC Outpatient Rehabilitation. “Health Matters” is a column meant to educate readers about their personal health, public health matters, and public policy as it affects health care. For this article and others like it, visit