Opioids are the most common form of chronic pain management for patients in the U.S. Unfortunately, they also are highly addictive with a number of detrimental side effects. Alternative methods of pain management often are not provided in mainstream medicine due to the presence of pharmaceutical companies in healthcare. However, there are several ways you can manage your chronic pain without risking addiction or relapse if you already have recovered from an addiction to painkillers. Here are a few of your options for managing pain without medication.
Exercise is Highly Effective
Though it can be very difficult to exercise with chronic pain, the more you exercise, the less pain your will experience. Regular exercise will stretch the muscles, reduce inflammation, and improve range of motion.
Mind Over Matter is Real
Meditation is another great way to manage pain. With practice, you will be able to move your mind to a place that does not feel the pain. Furthermore, meditation reduces stress and tension, two common contributors to chronic pain. It will not have an immediate effect because learning to meditate takes time. However, if you incorporate meditative practice into your daily routine, you will notice a difference.
Herbal Remedies May Help
For some people, herbal remedies can be very effective in managing pain. Turmeric, in particular, is known for its powerful anti-inflammatory properties. You either can add these helpful herbs into your diet or take supplemental capsules. Just be sure to steer clear of homeopathy as it has been proven completely ineffective.
Physical Therapy Can Make an Important Impact
Some worry that too much movement will amplify their pain, but physical therapy can relieve many kinds of chronic pain conditions, including rheumatoid arthritis, migraines, and fibromyalgia. Physical therapy helps strengthen muscles and increase flexibility. It can also teach patients to avoid painful movements or postures throughout the day so they can proactively prevent issues on their own. The results aren’t instantaneous but with commitment and patience, you and your therapist can find the best techniques for your condition and decrease pain over time.
Watching Your Diet May Be an Easy Fix
Inflammation is typically the main cause of chronic pain. If you aren’t watching your diet, you may be unintentionally eating foods that cause inflammation and not getting enough of those that reduce inflammation. Try combing through your diet and collecting new recipes. You might just be surprised by how much your diet affects your pain levels.
Consider Treatment for Underlying Issues
Studies are beginning to show that there may be a link between mental health problems and chronic pain. People with anxiety tend to experience chronic pain as do people with poor health overall. If your chronic pain has not been explained, seek out other forms of treatment. With holistic care, you can get to the source of the problem rather than treating the symptom.
Suffering from chronic pain can make daily life difficult. Being faced with few options outside opioids certainly doesn’t make things easier. Rather than risk addiction to painkillers, try out a few of these methods. Keep in mind that not all chronic pain is the same and not every method will work for each situation. Test new methods until you find one that works.
Physical Therapy for Knee Pain may be just as beneficial as Surgery, a recent study suggests
A Finnish study published in the New England Journal of Medicine this week suggests that arthroscopic knee surgery for a torn meniscus may not do any more to alleviate pain than physical therapy. Meniscus surgery is the most common orthopedic surgery in the United States, with about 700,000 surgeries a year.
This study builds upon a 2002 Texas study which looked at surgery for knee osteoarthritis and a 2008 study which concluded that patients who received knee arthritis surgery did not fare any better than patients who did physical therapy and took medicine.
A 2013 study by seven hospitals in the United States found that in patients with tears, surgery did not result in greater improvement than physical therapy alone. However, after six months, patients who did not get surgery did opt to get surgery.
As a result of the growing research, many physicians are advising patients to try physical therapy first. They also recommend that patients are properly screened to determine who will benefit from surgery; such as those with tears from an acute sports injury or younger patients.
Physicians are advising patients to try physical therapy first; the benefits of reducing swelling, increasing strength and neuromuscular re-education are significant.
Roger Nelson, PT, PhD, FAPTA was honored at the APTA conference yesterday as the presenter of the Mary McMillan Lecture. An innovator in the field who is held in very high regard for his long history
of distinguished service to the profession, Nelson spoke on physical therapy’s “Next Evolution”.
Primary to Nelson’s message is that it is how the PT care delivery system adapts to the new and rapidly changing healthcare environment that will determine our future. It is crucial that we plan and implement the necessary strategies while maintaining a focus on the delivery of quality care.
Some of the reforms will entail:
- Focusing on preventive care to maintain the population’s ongoing health
- Customization of therapeutic intervention
- Identifying and utilizing key metrics to assess outcomes, functionality, patient satisfaction and value
- Generating outcome reports with complete transparency
- Developing new payment systems that will pass tests of efficacy that will be required
- Providing scientific evidence that will predict the most successful treatments
- Recognizing that patients will have the ultimate control in the system and will demand value and trust in their healthcare providers
The primary question raised by Dr. Nelson was “How can our profession adapt?” Going beyond that, he challenged physical therapists to lead the rest of the healthcare industry in this effort. He noted that it is vital for PT’s to look beyond a patient’s obvious pathology and impairment and to instead “interact with all aspects of the patient and look at the environment in which each patient must succeed”. Physical therapists, Nelson offered, should integrate “the best of science with the art of a healer”.
Central to meeting the challenges facing the profession is the need to establish the value of PT to patients; to manage outcomes and expectations as they relate to function and pain. Also important is to clarify for payers the advantageous relationship between services rendered to outcomes received.
Nelson contended that PT must do the following in order to succeed:
- Utilize electronic records within the cooperative healthcare community to develop measurement of treatment goals across the professions
- Emphasize the importance of collecting data to drive the equation to justify care
- Define the role of costs in the delivery of PT services as well as in the purchasing of those services by patients and third party payers. With favorable outcomes data, physical therapy will be able
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to distinguish itself across treatment platforms to make our model the most cost effective, and cost efficient option for patients. If attention isn’t directed to these avenues, PT’s risk being undervalued.
- Develop an invigorated spirit of entrepreneurship and strategic innovation. This will enable us to establish new niches for our practices to expand our reach and offer additional services to our existing clients. Dr. Nelson suggested options such as PT’s becoming life
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coaches to be involved in the health and wellness of patients throughout their lifespans. He cautioned that we risk becoming stagnant if we fear failure when reaching for success through innovation.
- Further develop academic programs that prepare students to adapt to the new healthcare environment by focusing on their communication, critical thinking and practical research skills, on innovation and on entrepreneurship. Nelson reinforced that new ideas will lead to desired outcomes and greater opportunity.
- De-emphasize impairment ratings (such as ROM and MMT) as well as passive modalities in favor of a focus on each patient’s ability to function in his/her environment. Dr. Nelson reminded us that skilled interventions correlate with successful outcomes.
- Find new ways to encourage active association involvement (70% of therapists do not belong to the APTA) by improving the cost/benefit ratio. Nelson suggested possibilities such as tiered membership, identifying the needs of individual members in order to provide each with specific information of interest and an expanded platform for idea sharing and community problem solving. He proposed involving a wider spectrum of contributors to present their ideas via TED type talks and the possibility of reduced corporate membership rates to therapists employed by large entities.
Dr. Nelson’s clear message was that it is definitely a time for the profession of physical therapy to move forward by shedding some of the past and planning thoughtfully to be a force that controls its destiny. If not, outside forces will undoubtedly control us.
Follow Abby Sims on Twitter @abcsims.
April is Parkinson's Disease Awareness Month and physical therapists are doing their part in working with those afflicted with a disease that affects so many, my father amongst them.
Studies suggest that exercise that begins immediately after a Parkinson diagnosis can have a profound effect on the symptoms and side effects of the disease. Learn how a physical therapist can help someone with PD stay as active and independent as possible by listening to @MoveForwardPT’s “Parkinson Disease and the Role of Physical Therapy,” radio segment http://bit.ly/15oyCAd.
You can learn more about physical therapy's role in the treatment of Parkinson's by watching the video Parkinson Disease: Treatment by a Physical Therapist, listening to the APTA's podcast on Parkinson Disease and the Role of Physical Therapy or reading the Physical Therapist’s Guide to Parkinson Disease,
In our recent newsletter, we shared Ten Tips about how to get the most out of your physical therapy visit. As with many things, you get out what you put in to your physical therapy visit. Here are Ten Tips to help you get the most out of your visit.
Ten Tips to Get the Most out of your Physical Therapy Visit
1. Be on time for all appointments. In fact, come a little early for your first appointment. There is always paperwork to sign and insurance information to be exchanged.
2. Come prepared for your first visit. Bring your Dr’s prescription, insurance card and work out clothing. If possible, download our new patient forms and fill them out prior to your first visit at: https://www.recoverypt.com/Insurance-And-Forms.php.
3. Wear exercise clothes and shoes to physical therapy.
4. Put the Blackberry and cell phone away during your appointments. If you can’t bear to part with it, at least put it on vibrate so it does not disturb other patients. Please, do not talk on your cell phone during appointments.
5. Schedule enough time for your appointment so you are not rushed. Usually one hour of treatment time is sufficient, but check with your PT when planning your future appointments. Don’t forget to factor in travel time to and from the facility.
6. Come to physical therapy as prescribed by your physician – usually 2-3 times per week, depending on your specific condition. There is a reason why the Dr prescribed
a specific number of visits. Don’t hesitate to ask your PT questions.
7. Remember, healing is a process and takes time. Healing doesn’t happen overnight.
8. Do your home exercises everyday. And if the PT tells you to do them twice per day, he/she really means twice per day.
9. Be Present. Focus on your physical therapy while you are at our facility. Put work and home issues aside. Focus on yourself during your visit — this is your time.
10. Come with a willingness to learn and heal. You will discover your body’s miraculous ability to heal itself.
The TMJ or temporomadibular joints, located in the jaw, are the most frequently used joints in the body and are used hundreds of times throughout the day.
Although pain in the TMJ area is usually dental, like any other joint, pain can be musculoskeletal as well. Some of the causes of TMJ disorders can be:
- Disc displacement: the disc can sublux or dislocate causing painful clicking, popping or locking
- Arthritis: both osteo (from overuse or trauma) and rheumatoid (due to autoimmune reasons)
- Muscular: repetitive overuse, muscle imbalances and postural changes that affects the forces on the disc and joint surfaces resulting in pain
- Other trauma; such as, major dental work, wisdom tooth extraction or sustained positions which can initiate irritation and cause pain.
Symptoms that often accompany TMJ disorders are headache, neck pain and shoulder pain.
Effective and comprehensive Treatment of TMJ disorders should include a mouth piece fabricated by a specialized dental practitioner and physical therapy from a TMJ specialist. The mouth piece will put the TMJ in a better
resting position and reduce stresses on the joint, discs and muscles.
Physical therapy with a TMJ specialist begins with a full musculoskeletal evaluation. Treatment includes: specific postural re-education of the facial and neck muscles to restore their normal function. Manual therapy is also used to stretch and release tight muscles and myofascial tissue, as well as mobilization of stiff joint capsules and ligaments to increase motion. Instruction on proper home exercises and ergonomic education to prevent further problems is also integral to a successful treatment program.
For more information, please contact Erik Hofmann, Certified TMJ Specialist, Director, Larchmont Facility, Recovery Physical Therapy, (914) 834-7222.
According to a recent study in the journal Health Services Research, patients who bypassed the physician and went directly to a physical therapist, had, in many cases, lower overall costs, fewer visits and lower overall healthcare use for the injury. The study also showed that patients who self-referred were just as active with medical care before, during and after treatment, proving that continuity of care is not comprised.
New York is a Direct Access state, which means that patients can go to a physical therapist without a Doctor's prescription.
Although many conditions, especially those that
require a more in depth diagnostic workup, should be managed through a physician, there are a number of instances where seeing a physical therapist through direct access makes very good economic sense without compromising outcomes.
For more information about this study, visit:
The NY Times Phys Ed blog had a very interesting piece a few days ago about the use of cortisone shots. In short, recent studies have suggested that while effective for temporarily “masking pain”, cortisone shots may actually be detrimental to long-term sustained recovery. Patients who relied on cortisone shots as their primary method of recovery fared much worse 6 months and 12 months after treatment versus those who instead relied solely on physical therapy and the passing of time to restore function.
Here’s a key excerpt from the NY Times blog post:
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The review examined the results of nearly four dozen randomized trials, which enrolled thousands of people with tendon injuries, particularly tennis elbow, but also shoulder and Achilles-tendon pain. The reviewers determined that, for most of those who suffered from tennis elbow, cortisone injections did, as promised, bring fast and significant pain relief, compared with doing nothing or following a regimen of physical therapy. The pain relief could last for weeks.
But when the patients were re-examined at 6 and 12 months, the results were substantially different. Over all, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach. The evidence for cortisone as a treatment for other aching tendons, like sore shoulders and Achilles-tendon pain, was slight and conflicting, the review found. But in terms of tennis elbow, the shots seemed to actually be counterproductive.”
Read the complete article at this link: NTimes.com – Phys Ed: Do Cortisone Shots Actually Make Things Worse?