Physiotherapy Reduces Opioid Use

In particular, Australia sees almost 150 hospitalisations for opioid harms daily.3 Moreover, Amanda Roxburgh and colleagues (National Drug and Alcohol Research Centre, University of New South Wales) attribute 70% of opioid-related mortality in Australia to pharmaceutical opioids.4 The crisis is well publicised, and the healthcare community is strategizing ways to reduce the problem.5,6

When considering how to reduce the burden of opioid-related harm on communities, one prescribing practice to keep in mind is physiotherapy. In July, PM&R published the work of Lindsey Brown-Taylor, PT, PhD, et al., “Relationships between physical therapy intervention and opioid use: A scoping review.” Previously, the Advanced Physiotherapy bulletin covered a study in the Journal of the American Medical Association that followed more than 63,000 total-knee replacements and found a 25% reduction in the risk of long-term opioid use across most categories.8

Additionally, this bulletin reported on a study of nearly 150,000 back pain cases. It found that physiotherapy on day-one of the back pain presentation reduced opioid use 89% compared to no physiotherapy. Later referrals to physiotherapy also reduced opioid use but to a lesser degree.9

In the current study, Brown-Taylor et al. took a novel approach. They performed a scoping review of all studies with a physiotherapy intervention that reported an opioid-use outcome. They found 30 studies evaluating physiotherapy in one or more of these categories: interdisciplinary programs, modalities, treatment, utilization, content, timing, and location. Studies about timing are the largest subset— 43%. Reviewers found mixed results for interdisciplinary programs and modalities. Emergency department physiotherapy did not reduce the number of opioid prescriptions. 

Physiotherapy at rehabilitation centres was found not inferior to physiotherapy from inpatient facilities. On the other hand, utilising physiotherapy was associated with lower use of opioids across a range of conditions: back pain, spine pain, joint pain, and work injuries. Most of the studies evaluating timing found that immediate or early physiotherapy initiation produced the best outcomes. The generalised result is that repeated, professionally guided sessions of exercise therapy reduce opioid use 20% to 80% across all diagnoses studied to date.

References

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2. World Drug Report 2021 (United Nations publication, Sales No. E.21.XI.8): www.unodc.org/res/ wdr2021/field/WDR21_Booklet_2.pdf

3. Australian Institute for Health and Welfare (AIHW). Opioid harm in Australia and comparisons between Australia and Canada. Canberra, Australia: AIHW; 2018.

4. Roxburgh A, Hall WD, Dobbins T, Gisev N, Burns L, Pearson S, Degenhardt L. Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug and Alcohol Dependence. 2017 Oct 1;179:291-8.

5. Lam T, Hayman J, Berecki‐Gisolf J, Sanfilippo P, Lubman DI, Nielsen S. Pharmaceutical opioid poisonings in Victoria, Australia: rates and characteristics of a decade of emergency department presentations among nine pharmaceutical opioids. Addiction. 2022 Mar;117(3):623-36.

6. Chaillon A, Bharat C, Stone J, Jones N, Degenhardt L, Larney S, Farrell M, Vickerman P, Hickman M, Martin NK, Borquez A. Modeling the population‐level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia. Addiction. 2022 May;117(5):1338-52.

7. Brown‐Taylor L, Beckner A, Scaff KE, Fritz JM, Buys MJ, Patel S, Bayless K, Brooke BS. Relationships between physical therapy intervention and opioid use: A scoping review. PM&R. 2022 Jul;14(7):837-54.

8. Aoyagi K, Neogi T, Peloquin C, et al. Association of physical therapy interventions with long-term opioid use after total knee replacement. JAMA Network Open. 2021; 4(10):e2131271.

9. Frogner BK, Harwood K, Andrilla CH, Schwartz M, Pines JM. Physical therapy as the first point of care to treat low back pain: an instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs. Health Services Research. 2018 May 23. DOI: 10.1111/1475-6