Viewpoint

Apply Integrated Care To Our Opioid Crisis


Eric Lederhaus
Crossover Health
Rebecca Sanders Fung
Crossover Health

Every day more than 1,000 Americans are treated in emergency departments for misuse of prescription opioids. About 115 Americans die every day from opioid overdoses. What was once a broadly used treatment solution has spiraled into a widespread health crisis that is prompting everyone—families, community organizations, physicians, health care systems—to demand better solutions.

Eric Lederhaus

Rebecca Sanders Fung

One need look no further than the #ChoosePT campaign by the American Physical Therapy Association (APTA) or the opioid awareness efforts of the American Chiropractic Association to see how the nation’s health care experts are turning to proven alternatives to help patients manage their pain rather than mask it. As APTA President Sharon Dunn recently told our team of physical therapists, “No one should put their health at risk in an effort to be pain free. For too long, Americans have relied on opioids alone to manage chronic pain.” Although opioids are appropriate in some cases, said Dunn, the CDC has identified alternative approaches to avoid or reduce opioid use.

Between 2000 and 2010, according to a 2013 multi­author report in the journal Medical Care, the reported rate of provider-diagnosed pain nearly doubled while the rate of patient-reported pain stayed the same, despite a dramatic increase in opioid prescribing. In other words, opioids are not significantly reducing experiences of pain. Thanks to significant investment in pain research in recent years, we now understand that chronic pain is complex and multivariable, so it can neither be easily diagnosed nor solved. When diagnosing and treating pain, doctors must balance a patient’s symptoms with medical analysis, weighing the risks and potential benefits of different treatments. This is particularly true given the reality that opioids come with increased risks of addiction and death and are not effective as long-term solutions to chronic pain.

The most innovative health care providers are transforming traditionally siloed models of care into integrated hybrids that bring musculoskeletal and other experts together with primary care physicians. As physical therapists, we work closely with primary care doctors, behavioral health therapists, and health coaches in collaborative hubs. We huddle daily to confer about the best care plans for our patients and update each other on the latest research in our fields.

If a patient has debilitating anxiety and sleep disturbances from underlying stressors at work, working with a psychologist and sleep specialist may be the best way to start mapping the road to recovery.

If a patient’s cause of pain is tissue load intolerance, then physical therapists and chiropractors can assist in guiding the patient in gradually building up strength and tolerance in the highly sensitive tissue. Our noncancer primary care patients are prescribed opioids approximately 10 times less frequently than the estimated national average. As these approaches enter the mainstream of American pain treatment, we expect to see less reliance on efforts that mask pain and more on those that truly relieve it.

Primary care physicians must offer alternatives to pain management beyond prescription painkillers. Treatments like physical therapy, chiropractic, acupuncture, and cognitive behavioral therapy—including relaxation training, pleasant-activity scheduling, and guided exercise—are recognized by the CDC and the Alliance for Health Policy as more cost-effective, results-driven solutions to pain management than opioids.

Integrated care models, in which primary care doctors work alongside specialists in pain management, physical therapy, and behavioral health, are revolutionizing health care in the United States. These models foster the kind of collaboration that is needed to treat complex, multifaceted problems like chronic pain. They are among our best hopes for an alternative to the overuse of prescription painkillers that has caused so much suffering and early death.

Eric Lederhaus, DPT, and Rebecca Sanders Fung, DPT, are physical therapists at Crossover Health in Mountain View, Calif.