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The American Physical Therapy Association (APTA) reported that in 2015, death from drug overdoses occurred more than gun homicide or car crashes combined.¹ It is estimated that 15 million people are addicted to opioids worldwide and 69,000 people die from opioid overdose each year.² Opioids attempt to relieve patient’s chronic pain but cause impairments that affect judgement and cause psychomotor agitation which ultimately prevent people from participating in social and occupational roles.³ Additional adverse effects can include drowsiness, coma, impaired attention, impaired memory, and slurred speech.³ The Centers for Disease Control and Prevention (CDC) has attempted to implement guidelines for opioid prescription but opioid abuse has proved to be a prevailing issue the United States is continuing to battle¹ In addition, the CDC recommends non-pharmacological approaches, such as physical therapy, over opioid medication for chronic pain.²

Based on a survey of 62,000 Americans, 78% of those surveyed would prefer drug free pain management over opioids; however majority of those survey stated they would seek care from a physician, chiropractor, or massage therapist before seeking a physical therapist.² It is believed this is due to a lack of public awareness about what physical therapy has to offer.² Therefore, the physical therapy profession is stepping up to help address this issue through the APTA’s nationwide #ChoosePT campaign.¹ The physical therapy profession has a unique opportunity to take the lead role in healthcare and health promotion, with the goal of reducing the need for more dangerous health interventions like opioid medication.² While opioids just mask pain short-term, physical therapists can offer their expertise on human movement to provide safe pain relief long-term and without adverse side effects experienced by drugs.¹ Physical therapists can prescribe exercises specific to the goals and needs of the individual patient. Research shows that those who exercise more than 3 times per week were 28% less likely to experience chronic widespread pain.⁴ In addition, physical therapist can use other techniques such as manual therapy and various modalities for pain management.⁵

References

1. APTA Statement on President’s Commission on Combating Drug Addiction and the Opioid Crisis. https://www.apta.org/Media/Releases/Consumer/2017/4/4/. Accessed October 13, 2019.
2. Mintken PE, Moore JR, Flynn TW. Physical Therapists’ Role in Solving the Opioid Epidemic. J Orthop Sports Phys Ther. 2018;48(5):349-353. doi:10.2519/jospt.2018.0606
3. Goodman CC, Fuller KS. Pathology – E-Book: Implications for the Physical Therapist. Elsevier Health Sciences; 2014.
4. Holth HS, Werpen HKB, Zwart J-A, Hagen K. Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study. BMC Musculoskelet Disord. 2008;9:159. doi:10.1186/1471-2474-9-159
5. 4 Ways Physical Therapists Manage Pain. American Physical Therapy Association. https://www.choosept.com/Resources/Detail/how-physical-therapists-manage-pain. Published June 27, 2016. Accessed October 13, 2019.

Colleen Manning, SPT

Morgan Richards, SPT

Did you know that certain foods can cause inflammation within your body? Studies show that asthma, allergies, joint pain, premature aging, diabetes, and obesity can all be linked to inflammation throughout your body. Doctors and nutrition experts suggest eating primarily a whole-foods, plant-based diet to decrease this inflammation and improve overall health. Below, we will suggest anti-inflammatory foods, foods to avoid, and cost-effective ways to decrease risk of disease, mood disorders, and overall stress levels.

What you eat can help combat the amount of inflammation that is causing your symptoms, including those experienced with osteoarthritis. The first-line defense against inflammation includes “optimal nutrition” and exercise. While physical therapy targets the exercise interventions you need to get back to your highest quality of life, what you eat is just as important. So what is the “optimal nutrition” you need to fuel your body? Each person is different, however a diet focussed on anti-inflammatory, plant-based foods shows resounding positive effects across inflammatory diagnoses. An anti-inflammatory diet includes: whole grains, vegetables and fruits, beans, split peas, chickpeas, and lentils. Certain spices also contribute to decreased inflammation in one’s system, including: rosemary, turmeric, cloves and ginger. Adding these spices into dishes, while also incorporating the aforementioned anti-inflammatory foods, will help combat the negative effects of inflammation seen in today’s society. With a proinflammatory diet so prevalent in today’s western culture, it is imperative that we focus on properly fueling our bodies to fight inflammation.

Rheumatoid arthritis has also been shown to respond to a plant-based diet, as the antioxidants present in plants decrease the inflammation in one’s system. Nuts are an important source of protein to add to any plant-based diet and provide helpful fats. Multiple Sclerosis (MS) is another condition receiving recognition for responding to a plant-based diet, as demonstrated by the Swank diet. To learn more about the specifics of this cost-effective strategy to managing symptoms of MS, please visit the link provided at the bottom of this paper.

While there are many foods that help decrease inflammation in the body, there are also a number of foods that increase the inflammatory response and can exacerbate your symptoms. Processed sugars can trigger the release of inflammatory messengers. Saturated fats, which are high in red meat products, full-fat dairy products, and desserts, trigger inflammation in the fat tissue. Trans fats are another type of fat that trigger inflammation, especially throughout the body. Trans fats are found in many fast food products and processed foods. Refined carbohydrates contain ingredients that increase inflammation, so it is important to limit the consumption of white flour products, white rice, and processed cereals. MSG is a food additive that is often put in foods to enhance their flavor, but it can trigger chronic inflammation pathways and also impair liver health. Aspartame is another ingredient that is added to foods for flavor enhancement, but is actually a neurotoxin that causes your immune system to trigger an inflammatory response. Finally, alcohol is a food that can cause inflammation by impairing liver function and interfering with other organ function. As you can see, many of the foods that we consume daily contain ingredients that cause increased inflammation within the body, and it is important to limit the consumption of these foods.

With a little spin on the classic saying “an apple a day keeps the doctor away”, a balanced diet consisting of plant based and whole foods keeps the inflammation away! In addition to providing a first-line of defense against inflammation, changing to consumption of a more balanced diet can significantly benefit the success of people with chronic diseases that medication and invasive procedures cannot assist in. Before altering your daily eating habits, consult with your physician on appropriate steps to take to find an exact balance appropriate for your condition. You have the power to prevent and manage your condition by making a positive lifestyle change. Learn more about taking a proactive approach to health and learning about improving your diet through visiting www.nutritionfacts.org.

Resources:

http://nutritionfacts.org

http://www.arthritis.org/living-with-arthritis/arthritis-diet/foods-to-avoid-limit/food-ingredients-and-inflammation.php

http://www.swankmsdiet.org/the-diet

Kathryn Coughlin, SPT
Kayla Francis, SPT
Chelsea Oswald, SPT
Sonia Shah, SPT

RISKS

Over the past 20 years, Americans have increasingly been prescribed very powerful painkillers including Vicodin, OxyContin, Opana, and methodone, as well as combination drugs. While at times prescribing opioid use to specific patients is appropriate, there are many potential side effects including depression, overdose, addiction, and withdrawal symptoms. Additionally, the use of these drugs is more for masking the pain versus treating the root of the problem. The utilization of physical therapy can assist patients with safe pain reduction as well as education and understanding of their pain.

FUNCTION

According to the CDC’s Guideline for Prescribing Opioids for Chronic Pain, there is high quality evidence that exercise, as a part of physical therapy, can improve function and decrease pain for many chronic pain diagnoses. Physical therapy may accompany a multi-modal approach to decrease pain in order to maintain the patient’s current level of function or return to activities that he or she enjoys. By increasing the pain free activity participation and tolerance, the patient may experience a greater quality of life. A physical therapist may assist by recommending the most beneficial exercises for a specific patient based upon his or her impairments and goals. The PT may guide and educate the patient so that the he or she can safely perform the exercises to maximize their functional levels.

COSTS

Dealing with a condition such as low back or neck pain can be very costly. Several routes can be taken for pain reduction, including opioid medications, spinal injections, or even surgery. There is a growing body of evidence that demonstrates the early use of physical therapy for cost reduction and long-term results. According to MoveForwardPT, early physical therapy can decrease the recurrence of low back pain, and it may be the best choice for the avoidance of future low back pain. Additionally, a study in 2013 discussed that physical therapy is just as effective as surgery for spinal conditions such as degenerative disc disease. When considering the route to take for your injury or pain, #ChoosePT first, and consider The Ohio State Student Therapy Clinic for free physical therapy services for uninsured and underinsured residents of central Ohio!

Disclaimer: It is recognized that there are certain situations, such as cancer, palliative care, and end of life care where opioid use is appropriate. It’s important to weigh the potential risks versus the benefits in order to determine the best path for you!

Resources:

http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

http://www.moveforwardpt.com/Default.aspx

https://www.ncbi.nlm.nih.gov/pubmed/24047821

Kathryn Coughlin, SPT

Jessica Stueve, SPT