Physical Therapy, a safer alternative to opioids

According to Therapeutic Pain Specialist at HSHS St. Elizabeth’s Hospital, physical therapy serves as a safer alternative to opioids for increased functionality, pain management and an overall improvement of a patient’s quality of life.

Stacie Dichsen, PT, DPT, WCS, pain specialist at St. Elizabeth’s, said that physical therapy programs to address pain begin with education on how our nervous system processes injury, disease and pain. Research has shown that understanding how the pain system in our body works is an important part of decreasing pain.

Dichsen said that a patient who is continuing to feel pain following the “acute phase” of their injury after tissues have had time to heal likely has an increase in the activity of the body’s nervous system. When the nervous system becomes extra sensitive pain persists. 

“With prolonged pain the primary source is not the tissues, it’s the complex system in the brain that continues to generate pain as a protective response,” she said.

Dichsen said that physical therapy will quiet the “hyper-vigilance” of the pain alarm system that exists in the brain.

“We start with gentle therapy, and a gradual increase in mobility,” she said. “For some patients I start with very simple exercise – walking consistently for five minutes and then gradually increase it.”

Dichsen said that physical therapists will look at each individual patient’s weaknesses and address their symptoms. “It’s a holistic approach.”

Through the physical therapy process, patients are taught to not “fear the pain” by gradually progressing specific exercises and activities to improve their daily activity level.

Director of Therapy Services at HSHS St. Elizabeth’s Hospital, Tom Dibadj, PT, DPT said that the hospital individualizes each patient’s treatment plan. While patients experiencing pain receive the same medication for the most part, physical therapy offers an assessment “to see what is causing the pain and the deficits a patient has.” 

Dichsen added that in addition to the addiction issues that revolve around opioids, they do not help to reset the pain alarm system in the brain.

“Patients often need higher and higher doses, and they are no longer working – which is often why we have the overdose issues,” she said. “The brain just needs more to mask that pain response.”

Dichsen said that physical therapy pain programs are designed to help quiet the pain alarm system and teach the patient that with initial exercise they may have soreness, but sore is safe and part of the process of getting better.

“When I’m explaining to someone about these pain centers, it’s important to let them know that we don’t think the problem is in their head. Instead, the pain is real and we need to reset the pain response their body is having,” she said. “Resetting that alarm is a gradual progressive process.”

“With physical therapy – our goal is to increase their function, increase their activity and their quality of life and help them learn to manage the pain. It doesn’t always eliminate their pain but it brings it down to a manageable level.”

Dichsen said that physical therapy treatment takes time depending on the severity of a patient’s condition.

“For chronic pain patients it’s a slower process and you have to go about exercises in a different manner. With athletic injury you can typically move them back to activity pretty quickly,” Dibadj said.

Dibadj said that the sooner a patient can see a therapist the better. “The longer you wait and continue with pain the longer it’s going to take to recover.”

Dibadj said that less than ten percent of people with back pain see a physical therapist yet a high percentage receive opioid prescriptions.

“There’s a disconnect on what is actually going to help in the long run versus short term relief that they think is going to last, but it doesn’t.”

Dichsen said that individuals shouldn’t fear physical therapy. If you any or anyone you know is experiencing persistent pain, seek physical therapy to help you improve your quality of life. For questions on physical therapy for managing pain, call St. Elizabeth’s Outpatient Physical Therapy department at 618-607-5103.