Capital Region | Capital Health | Summer 2020

crmc.org 3 Do you have low- back pain (LBP)? If so, you’re not alone. Low-back pain (LBP) is an extremely prevalent problem for all involved, from those who have it to health care providers, to everyone on the periphery: employers, insurers, caregivers—the list is extensive. It is the leading cause of disability in the world, and there is no easy solution. 1 Over the past several years, the treatment recommendations for LBP have evolved, in large part due to the monstrous opioid epidemic that claimed nearly 47,000 lives in 2018 alone, with 32% of those overdoses involving prescribed medications. 2 So how can you treat the pain without the opiates? The newest recommendations for LBP from the American College of Physicians and The Lancet suggest that noninvasive and nonpharmacological treatments, such as physical therapy (PT), should be the first steps in treating pain. PT has been shown to be a cost-effective method of treating LBP as well; these cost savings are greatest with timely referral to PT. When compared to patients who received PT later or never, patients who saw a physical therapist first had a lower probability of having an opioid prescription, any advanced imaging services or an emergency department visit. 4, 5 This decreased the use of high-cost medical services and shifted the cost away from pharmacies and outpatient services toward provider settings. With a timely referral to physical therapy, patients can mitigate costs and maximize recovery. 4 Patients who participate in PT have also been shown to use opioids less, which suggests it’s a safe and effective option to combat the opioid crisis. Data shows that early use of opioids is related to longer work disability and worse overall function. Patients who saw a physical therapist early after their diagnosis were 89% less likely to receive an opioid prescription at follow-up visits. 4 Ultimately, the more physical therapy a patient participates in, the less likely they will be prescribed an opioid for pain. 5 Be an advocate for your care—ask your doctor if PT is the right option for you! Less than half of patients seen for new-onset LBP are referred to PT, despite it being one of the most strongly supported recommendations for treatment. PT can reduce overall health care costs; decrease opioid use; and be an effective method for treating pain, improving overall function and reducing disability. The most promising treatments are those with a multidisciplinary approach that focuses on education, promoting activity, reducing work disability and improving function, and PT is a crucial component in that plan. 3 Low-back pain? We can help Brianna Cowley, PT, DPT 1 Qaseem, A., Wilt, T. J., McLean R. M. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 166(7), 514-533. 2 Centers for Disease Control and Prevention. 2020. Opioid Overdose: Data. https://www.cdc. gov/drugoverdose/data/index.html 3 The Lancet. 2018. Low Back Pain. https://www.thelancet.com/series/low-back-pain 4 Frogner, B. K., Harwood, K., Andrilla, C., Schwartz, M., & Pines, J. M. (2018). Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health services research, 53(6), 4629–4646. https://doi.org/10.1111/1475-6773.12984 5 Thackeray, A., Hess, R., Dorius, J., Brodke, D., & Fritz, J. (2017). Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain. Journal of the American Board of Family Medicine : JABFM, 30(6), 784–794. https://doi.org/10.3122/jabfm.2017.06.170064 6 Garrity, B. M., McDonough, C. M., Ameli, O., Rothendler, J. A., Carey, K. M., Cabral, H. J., Stein, M. D., Saper, R. B., & Kazis, L. E. (2020). Unrestricted Direct Access to Physical Therapist Services Is Associated With Lower Health Care Utilization and Costs in Patients With New- Onset Low Back Pain. Physical therapy, 100(1), 107–115. https://doi.org/10.1093/ptj/pzz152 Back to your best Find out how our expert physical therapists can help with your low- back pain. Call 573-632-5614 for more information.