Posts tagged opioids
90% Of Patients With Back Pain Are Not Referred To Physical Therapy After Seeing Primary Care First

Low back pain, along with death and taxes, remains one of the certainties of life. This condition affects over 90% of Americans and is often benign, but painful, in nature. Currently spending on low back pain is over 100 billion dollars a year and much of this spending can be attributed to unnecessary and unwarranted tests and interventions including early imaging (x ray, MRI, CT scans), advanced procedures (injections, surgery) abnd office visits. Consistent with many musculoskeletal conditions, early treatment of acute low back pain accelerates a patient’s recovery and may be our best strategy at reducing health care spending and excessive treatments. Our previous blog posts have highlighted the benefits of direct access to Physical Therapy services or patient self referral including cost savings of $1000-1500 per episode of care. Despite the clinical and cost effective benefits of Physical Therapy, a recent study highlights the limitations of seeing a primary care physician first for low back pain.


Authors in the journal Spine analyzed over 170 million medical office visits for low back pain between 1997 and 2010 to determine health care utilization rates for this condition (Zheng et al. 2017). Authors found on average only 10% of patients with low back pain were referred to Physical Therapy after seeing a physician first and this rate remained stagnant over the study time period. Lower referral rates were found for patients covered by Medicare and Medicaid. Conversely, opiod prescriptions increased from 15% to 45% through the study’s 13 years of data collection. Authors found patients not referred to Physical Therapy were more likely to receive an opioid prescription.

Patients are encouraged to utilize direct access or advocate for a Physical Therapy referral for early treatment of their back pain symptoms.

Early Physical Therapy Associated With Reduced Long Term Opioid Use

Each day over one hundred Americans die from an opioid overdose. Over prescription and use of prescription pain relievers has largely contributed to these unnecessary deaths and the $78 billion dollar economic burden of the opioid epidemic. Authors estimate over 2 million Americans are currently suffering from a substance abuse disorder related to these prescriptions. Experts are now recommending non pharmaceutical pain relieving alternatives including meditation and Physical Therapy. Research strongly points to the early utilization of Physical Therapy as a safe, clinically and cost effective intervention for patients suffering from musculoskeletal pain. A new research study Physical Therapists may play in the opioid epidemic.

The Journal of the American Medical Association published a review article on the impact of early Physical Therapy on the utilization of opioid medication (Sun et al. 2018). Authors reviewed the cases of over 88,000 patients with neck, back, knee, or shoulder pain. Patient cases were then reviewed retrospectively to determine the type and amount of interventions utilized to treat these patient’s symptoms. Authors reported early Physical Therapy was associated with a significant reduction in the amount of opioids prescribed and the duration of these prescriptions. Authors recommended Physical Therapy as a first line intervention for a treatment of these musculoskeletal conditions.

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