Physical therapists should play a greater role in managing patients with opioid use and opioid misuse

Abstract

The U.S. opioid crisis necessitates that health care providers of all types work collaboratively to manage patients taking prescription opioid medications and manage those who may be misusing prescription opioids. Musculoskeletal conditions are the most common diagnoses associated with an opioid prescription. Physical therapists commonly manage patients with musculoskeletal conditions and chronic pain. Some patients who attend physical therapy for pain management take prescription opioid medications for pain and some of these patients may be misusing prescription opioids. Physical therapists who manage patients with musculoskeletal conditions are well-positioned to help address the opioid crisis. Historically, physical therapists have not been adequately engaged in efforts to manage persons with co-occurring musculoskeletal pain and opioid misuse or OUD. The American Physical Therapy Association (APTA) has emphasized physical therapy over the use of prescription opioids for the management of painful conditions. The APTA, however, does not highlight the important role that physical therapists could play in monitoring opioid use among patients receiving treatment for pain, nor the role that physical therapists should play in screening for opioid misuse. Such screening could facilitate referral of patients suspected misuse to an appropriate provider for formal assessment and treatment. This commentary presents simulated musculoskeletal patient presentations depicting 2 common opioid use states; chronic opioid use and opioid misuse. The cases highlight and interactions that physical therapists could have with these patients and actions that the physical therapist could take when working inter-disciplinarily. Recommendations are provided that aim to increase physical therapists’ knowledge and skills related to managing patients taking prescription opioid medications for pain.

Keywords:

• Physical therapy
• physical therapist
• opioid misuse
• opioid use disorder
• chronic opioid use

Author contributions

J.M., D.K., E.K., J.F., and A.G. conceived and wrote the manuscript.

Disclosure statement

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or any of its academic affiliates.

Additional information

Funding

This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002538 and National Institutes of Health [1UG1DA049444 (Greater Intermountain Node)]. Infrastructure support was provided by the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy and the Department of Veteran Affairs’ Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center [CIN 13-414]. Supporting organizations had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.