Posted on 10/12/2020
For the management of some types of pain, prescription opioids can certainly help. However, there is not enough evidence to support prolonged opioid use for chronic pain. We sat down with Katie McBee, P.T., DPT, OCS, M.S., CEAS II, PYT-C, regional director of our WorkStrategies Program, to ask her a few questions regarding opioid use, chronic pain and the benefits of physical therapy as a safe alternative to prescription medication.
1. In your opinion, what are the main reasons for the opioid epidemic in the United States?
There is no simple explanation as to what caused the opioid epidemic in the United States. Opiates are not a new drug and have been abused at other time periods in American history, but not nearly to the extent that is happening now. For example, with health care access issues due to COVID-19, opioid prescription rates are on the rise with death rates up 30% since the pandemic’s onset.
Initial research on opiate medications said they were effective and safe and addiction was rare when used for short-term pain.1 The development of FDA approved OxyContin in 1995 had labeling that stated iatrogenic addiction was “very rare,” and a widespread marketing campaign to physicians started to build medical providers’ confidence in prescribing these medications to decrease pain-related suffering.2 Add to that the 2001 standards implemented by the Joint Commission on Accreditation of Healthcare Organizations for organizations to improve their care of patients with pain medication and this is probably what catalyzed the beginning of our current opioid epidemic.
With medical providers focused on pain as a vital sign, pain quickly became the enemy and had to be eradicated to show successful management for many conditions with an increased focus on post-operative pain management. As drugs became more widely available, aggressively advertised and culturally acceptable, a three-fold increase in prescription rates for these medications ensued. With the increase in opioid prescription rates, death rates from side effects also increased by three-fold to more 16,000 in 2011.
2. What is the difference between chronic pain versus pain suffered as a result of an injury?
Pain is a mechanism designed to protect us from harm. Pain is not the enemy. A common misconception about pain is that it is not a simple cause/effect relationship. The amount of injury does not equal the amount of pain we experience. Pain is a complex process based on many areas of the nervous system and the brain communicating together to let us know what we need to prioritize and protect. The more threatening the brain perceives something, the more we potentially feel pain.
Acute pain or pain suffered immediately after an injury or surgery to the body’s tissues is a protection mechanism from the brain to remind you to protect the area so that no further harm is done. As the tissue heals and time passes, there is less threat of injury so the brain stops signaling, the pain eases and you slowly get back to normal activities.
In chronic pain, the tissues are not signaling danger to the brain as much as they are in acute pain. When the brain perceives threat for extended periods, it starts to change the nervous system to become a pain-producing machine. It creates new nerve junctions to make things hurt that wouldn’t normally hurt, like light touch on the skin. It can decrease the amount of pressure needed to create a pain signal. It creates more chemicals along the nervous system so it can create greater pain experiences with fewer stimuli. Research is still trying to figure out why some individuals have pain that goes away as the tissues heal and others have pain that persists despite the fact that the tissue has healed.
Individuals can be at risk of developing chronic or persistent pain for a number of reasons, including unhelpful coping strategies, stress, chronic illness and poor sleep habits. It appears the more emotional or physical stress going on at the time of the injury and/or during the healing process, the more at risk you can be of developing a persistent pain issue. A holistic approach to address some of these drivers of persistent pain is showing promise in being able to reduce the pain and get people with chronic pain back into their normal lives again.
3. Why is physical therapy important and what are some of the benefits to patients?
Physical therapy is an ideal treatment for many types of acute and chronic pain and should be a part of any single or multidisciplinary treatment plan for pain. The goal of physical therapy is to increase function and keep people in their meaningful life activities while they are healing. Physical therapists are trained to address many of the drivers of chronic pain and can perform testing and screening to see if your pain system is sensitized and adjust treatment to desensitize the pain system as well as address the functional limitations many people often experience when they are in pain.
Physical therapists have many tools they can use to decrease pain and desensitize the pain system. These tools include education on pain to discover what could be driving pain issues. Once the pain drivers are discovered, a physical therapist will develop a holistic plan to address these drivers, including increased activity, sleep hygiene, stress management skills and pacing techniques.
The best thing about physical therapy for pain is that the outcomes for some of the techniques are better than many medications and procedures available; plus, there are no negative side effects. If you or someone you know has an issue with pain, please request an appointment today to begin physical therapy treatment.
1. Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302:123.
2. Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health. 20:99 (2):221-227.
Posted on 10/7/2020
Up until a few months ago, my life as a physical therapist was pretty normal. I went to work, did my job, helped my patients and team to the best of my ability and went back home. At the time I was working in a critical illness recovery hospital with some of the sickest patients in my geographic area, people recovering from major trauma and significant illnesses. I was part of a great team, but it was heavy work. I felt myself becoming burnt out and struggling to do my best work. I have done hospital-based and outpatient work throughout my career, so I began to think that a transfer to Select Medical’s Outpatient Division might be my next move.
Fast forward a few months and interviews later and I accepted a site supervisor position at an outpatient center. About a month into my new role, COVID-19 wreaks havoc on the world. It was a daily pivot in terms of center operations and managing a team during a global crisis. I was also in a really unique position because I had spent almost 10 years working in critical illness, learning about cardiopulmonary physical therapy, infectious diseases and protective equipment. I felt confident I could lead my team effectively with the best information I had. As we started to move through the pandemic, our greater area was looking for someone to help lead a developing COVID-19 recovery program and I felt uniquely qualified.
Select Medical’s clinical team had put together a top-notch Recovery and Reconditioning Program for those compromised by a variety of acute and chronic conditions, such as after-effects of the flu and cardiovascular disease. Developed in partnership with leading physicians, including physiatrists and infectious disease specialists, the program focuses on identifying key areas of deconditioning and weakness in patients. Select Medical’s licensed physical and occupational therapist are specially trained in the program, with each clinician having access to the most up-to-date COVID-19 information, best practices and safety precautions.
Physical, occupational and speech therapy is critical in helping COVID-19 survivors get back to their lives and jobs. This virus can be extremely debilitating on its own, and even worse when combined with the effects of limited mobility during hospitalizations, prolonged mechanical ventilation or additional medical complications. As physical rehabilitation professionals, we are uniquely qualified to work with these patients to:
- Increase mobility, balance and stability
- Decrease pain, soreness and general fatigue
- Improve range of motion and breathing capability
- Address cognitive impairments, dizziness and weakness
- Ensure a safe recovery to activities of daily living
Our clinical team believes firmly in safety first and have put out guidelines for monitoring patients to ensure we are exercising them hard enough to make progress, but not overstress their systems. We are also educating these survivors on how to monitor themselves during home exercises or simple household activities like cleaning and chores.
While this global pandemic has had a lot of challenges and negative aspects, when I really step back and look at the whole picture I am impressed with how we positioned ourselves. Every day, we are committed to putting patients first, keeping patients and clinicians safe and assisting those who have survived COVID-19 back to their highest quality of life. That’s something to be proud of, and we look forward to helping more and more heal through our Recovery and Reconditioning Program.
By: Erica R. Noel, P.T., MSPT. Erica is a physical therapist with Banner Physical Therapy in Phoenix, AZ. Banner and NovaCare are part of the Select Medical Outpatient Division family of brands.
Posted on 10/2/2020
It's official, our favorite month of the year is here: National Physical Therapy Month. Please join us as we celebrate our amazing team members and the power of physical therapy throughout October. #NPTM2020 #ChoosePT #ThePowerOfPhysicalTherapy
Posted on 6/7/2018 by Annette Monaccio, O.T., CHT
Hand Therapy Week is held during the first full week of June and hosted by the American Society of Hand Therapists. Certified hand therapists are dedicated to helping patients with hand and arm injuries and conditions that may be affecting their daily life.
As a certified hand therapist, I’ve had the privilege to meet many people with a wide range of injuries. Watching an individual perform a task or activity that we often take for granted is a proud and exciting moment for both a patient and therapist after an injury.
I met Lexi, a shy and nervous young girl, who had been through a traumatic experience and hospitalization after a bon fire accident left her with severe burns over most of her body. She had spent several months at a local hospital in the intensive care burn unit. Upon beginning treatment, I knew that I needed to address and acknowledge her injuries, expectations of participation in therapy, boundaries for success and goals for recovery and independence.
Lexi had many burns on her face, arms, hands, torso, legs and back. There were many areas to address with her injuries, including:
Managing her wounds
Regaining mobility in her extremities
Performing basic activities of daily living, such as bathing, dressing and returning to school
Processing the psychological impact of others reactions to her appearance
I knew there were many things that we had to address quickly to avoid the loss of motion of her arms, especially her hands which were severely burned and beginning to form contractures/scarring along the fingers. We developed custom splints, “orthoses” made to fit the individual. It required many attempts for success due to Lexi’s injuries, but the key to our success was listening to determine the best splint, proper fit, adjustment and fashion for a preteen. A few color adjustments of splinting materials, a little added “bling” and voila, it was done and Lexi began wearing her orthotic!
The management of her wounds – cleaning, dressing, monitoring and education – were our first steps of trust and understanding, since this was one of the most difficult aspects of intervention. The next process of touching, moving and passively stretching her hands and fingers were the true challenge. Building trust and establishing goals were vital. We were on our way as a team to improve her ability to bend a finger, make a fist and then use her hands to accomplish daily tasks. There was blood, sweat and tears during many sessions, but, most importantly, there was a lot of laughter, too.
LexiLexi’s parents were dedicated to helping her in the center and at home for carryover of the program. As I watched her mom tie her shoes and write out some of the exercises we were reviewing one day, I asked Lexi why she wasn’t doing this on her own. She said, “I can’t do it myself.” This began the educational component with Lexi and her mom of why it was important to allow Lexi some reasonable time to attempt to gain her independence to complete daily tasks on her own. Yes, it was quicker and easier for someone to do this, but what would happen the first day back to school? Within two sessions, Lexi was independently putting on her shoes, tying them and had her first sense of independence since the accident.
Her laughter and smile were infectious with each new success. Next, Lexi was writing with adapting pens and pencils and back to writing poetry. Putting on her arm and leg compression garments and gloves was a tug of war match and she won each time. Again, another success. There were challenges of zipping a backpack, carrying books and fatigue following walks through the hallways in school, but Lexi overcame them all.
We initiated more challenges with fine motor skills with the purchase of a Barbie head and working on braiding hair. As a preteen, this was a must for Lexi. She now started braiding and had taken the focus of the hypersensitivity of her burns away to a new focus of allowing herself to touch different textures, which previously prevented her from using her hands for any activities. With each new challenge came a new set of frustrations, successes and, ultimately, independence.
Due to the extent of her burns, Lexi has been through several follow-up surgeries. She has returned each time to the center and hand therapy treatment with a new set of goals and motivation to quickly return to her routine. Step-by-step she continued to accomplish her goals, becoming independent with all activities. She now has excellent mobility of her arms, hands and legs.
Lexi has matured into a teen. She drives, attended prom, participates in track and other sports at school and has become a teen counselor at the burn camp she has attended each summer since her accident. I observed Lexi go from a quiet, scared child to an energetic and expressive young lady. She has taught me about determination, hard work and maintaining a positive attitude. She is an inspiration. I was not only the therapist, but the student learning each day from her.
By: Annette Monaccio, O.T., CHT. Annette is an occupational and certified hand therapist with Banner Physical Therapy in Arizona. She has treatment expertise in hand/upper extremity conditions and injuries, pelvic floor health and cancer rehabilitation.
Banner Physical Therapy, NovaCare and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.