A Better Prescription to Managing Pain and Opioid Use…

I had the pleasure to keynote the Inaugural ATI Forum in Chicago on the opioid epidemic and alternative treatments to chronic pain.

Experts from cross-sections of the U.S. healthcare industry met to discuss key influencers in the emergence of the opioid epidemic. Panelists explored alternative options for addressing management of pain and long-lasting solutions to help prevent opioid dependencies and ultimately save lives.

The panelists included Wajde Dabah, MD, Medical Director of Pain Therapy Associates, Matthew Belcher, JD, Partner at Aleksy & Belcher Law, Tom Allen, MD, Medical Director of BCBS-IL, and Thomas Denninger, DPT, of ATI Physical Therapy. Steven Ross Johnson, healthcare reporter, with Modern Healthcare moderated the panel discussion.

ATI Forum

For decades, long-term chronic pain management was widely believed to be controlled through opioids, such as Hydrocodone, Methadone and Oxycodone; however, new research suggests that opioids may only serve to merely mask or block the perception of pain. With more than 30 percent of Americans suffering from acute or chronic pain, the CDC has seen a major spike in opioid overuse and addiction cases, which should come to no surprise given the disabling effects of chronic pain.

In 2017 alone, opioids contributed to about 42,000 deaths, and recently, authorities are estimating that deaths in the related overdose epidemic are likely to increase by more than 70 percent. Opioid abuse was also just recently classified as an epidemic by the federal government. While many experts question the lack of long-term favorable results among most opioid users, the physical therapy industry is stepping up to be that beacon of hope for those in need. With a proven history in combatting aches, pains and discomfort, physical therapy is becoming a viable, non-medicated solution for those in search of remedying this physical and mental agony.

  • The CDC estimates more than 1,000 people are treated daily in ERs for prescription opioid misuse.
  • As reported by the CDC, opioid overdose deaths in the United States have quadrupled since 2000.
  • According to the National Institute on Drug Abuse, roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
  • A recent study by ATI Physical Therapy, My Health First Network, BCBS and Greenville Health System (GHS) found that 70 percent of patients that utilized physical therapy first for spine, shoulder and knee pain were successfully treated without the use of imaging, prescription medicine or additional physician visits.

Experts weighed in specifically on the lack of education, access to alternative treatments, and mismanagement of patient cases and how these variables have led to the increases in opioid misuse.

Education and making other [treatment] options known and readily available to patients are certain things we need to look at,” said Dabah. “Many patients don’t realize the negative side effects and the problems that result of an opioid addiction. There are alternative innovative technologies to opioids with less addictive properties that can help. It’s really just a matter of getting these chronic patients early to a pain specialist who can offer these new innovative tools. The closer you can get the gap to initial diagnosis to treating the pain, the more likely you are able to prevent chronic pain from developing.

Touching on the need for continued treatment and the role a patient’s mental health plays in the cycle, experts are urging the medical community take a more comprehensive approach to treatment.

Opioid dependence is like any other chronic disease in that it needs continual treatment and attention — it’s not something that you can fix and it goes away.

Opioid dependence is like any other chronic disease in that it needs continual treatment and attention — it’s not something that you can fix and it goes away,” said Allen. “A huge barrier in this situation is stigma. When you hear of someone who is opioid dependent, we associate it with someone on the street and get a picture of someone that is not like us, so it’s easy for us to assume it’s someone else’s problem. It’s stigmas like this that may prevent people from getting treatment.”

With this, it’s also important to focus on mental health,” added Dabah. “The correlation of depression and chronic pain is a 60% to 80% correlation because you can’t treat one without treating the other, so reaching out to ancillary [treatment] services to get everyone involved at the same time is the best way to combat this.”

Advocating for a more sustainable approach to documenting a patient’s succession through treatment, Belcher believes chart notes are a key component to helping a patient get the therapy they need.

Certain guidelines exist that are supposed to fit everyone, so if you write down that a patient has level 8 pain and after six weeks of PT (physical therapy), they have level 8 pain. I can guarantee you, that next course of PT is not going to be authorized. So you have to document in the medical chart notes that PT or these alternative modalities are helping the patient. If it’s not documented in the chart notes, the continued care is not going to be authorized.

For medical professionals, it’s important to document in the chart notes the progress being made,” said Belcher. “Certain guidelines exist that are supposed to fit everyone, so if you write down that a patient has level 8 pain and after six weeks of PT (physical therapy), they have level 8 pain. I can guarantee you, that next course of PT is not going to be authorized. So you have to document in the medical chart notes that PT or these alternative modalities are helping the patient. If it’s not documented in the chart notes, the continued care is not going to be authorized.”

From an ease-of-care and patient satisfaction perspective, ATI’s Denninger shared his thoughts on promoting an effective means to treatment rather than working towards an approval rating.

We need to hear these people.

When a patient goes to a medical provider, they expect something to be done,” said Denninger. “Sometimes it may be easier and best for a practice to make sure their patients feel satisfied on the way out. However, active care and time-to-care is crucial in helping a patient combat their pain. These people do need treatment, because left to their own devices, they will go into a persistent pain state, which puts them very much on a track for dependence. We need to hear these people. They need to receive care, but it should not be the easiest thing, which is a prescription. They should be put in a clear direction where they know they are being taken care of.”

For a full recording of the ATI Forum: Opioid Edition panelist discussion, please click here.

Alternative Therapies for Treating Chronic Pain

As we continue working towards an integrated system of care for the people, it’s important that as leaders in our respective industries, we see this epidemic as an opportunity to counsel these individuals on alternative treatment options and pull them out of the unforgiving addiction spiral. Programs like physical or cognitive behavioral therapies are known to successfully help individuals manage pain, so let’s help make a difference together.

(Note: Thanks to Brian Rog for his work on this piece and Sam Rood’s photos.)

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