PainRelief.com Interview with:
Steven Z. George, PT, PhD
Director of Musculoskeletal Research
Duke Clinical Research Institute
Vice Chair of Clinical Research
PainRelief.com: What is the background for this study? What are the main findings?Response: This study adds to existing health services research investigating the sequence of services/providers for musculoskeletal pain and its impact on opioid use.
The study suggest that early physical therapy (PT) for the 4 most common musculoskeletal conditions (back, neck, shoulder, and knee) can be protective of chronic/long term opioid use for individuals that were opioid naïve when presenting for their care. What is different about this study is that the 4 conditions were studied in the same cohort and the same definition of early PT was used (many of the previous studies just looked at 1 conditions, and used different definitions of early physical therapy). The other thing that was different is that we used a larger dataset of private insurance providers, so this study cuts across different regions of the study (many of the previous studies included one health system).
There was notable consistency in the findings for the 4 conditions and protection of any opioid use, but there were some contingencies.
First was that there was no benefit on decreased dosage for individuals with neck pain – as that was not expected.
Second was that in a follow up sensitivity analysis it looked like the largest benefit of early physical therapy may be for those with back and knee pain.
PainRelief.com: What should readers take away from your report?
Response: The biggest take away is that early physical therapy may be a viable option for several musculoskeletal conditions, especially if preventing long term opioid use is a treatment goal. This study DOES NOT suggest those receiving early physical therapy had better clinical outcomes, and that is an important thing to remember/note when interpreting the findings.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: This study should probably not be used to directly change anything, but it does provide encouragement/support for the updated guidelines from the CDC and ACP emphasizing non-pharmacological care being delivered early in treatment episodes. In this study the form of non-pharmacological care was PT and there seemed to be some benefit. This study provides early evidence that the new guidelines may help decrease long term opioid use.
Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open.2018;1(8):e185909. doi:10.1001/jamanetworkopen.2018.5909
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