Jennifer Levy, PT, physical therapist at the UVM Medical Center, talks about physical therapy as an alternative treatment option for pain. Physical therapy treats the underlying causes of their pain rather than masking it. Many patients and physicians think non-opioid approaches such as physical therapy may be better in some cases.
Listen to the interview at the link below or read the transcript that follows.
UVM Medical Center: Sales of prescription opioids have quadrupled in the United States. Tens of thousands of Americans are becoming addicted to opioids in large numbers and dying from overdoses at alarming rates. Hoping to avoid addiction and looking for ways to treat the underlying causes of their pain rather than mask it, many patients and physicians are considering whether non-opioid approaches such as physical therapy may be better in some cases.
Today on HealthSource, we’re joined by Jennifer Levy, one of our physical therapists at the UVM Medical Center, to talk about physical therapy as an alternative treatment option.
Thanks for being with us today.
Jennifer Levy: Thank you for having me.
UVM Medical Center: Why would a patient want to consider physical therapy rather than medication?
Jennifer Levy: Physical therapy is a great option for treating pain. Physical therapists are experts at identifying those factors which contribute to pain and developing a treatment plan to address those factors.
In addition to just focusing on decreasing the pain, the goals of physical therapy include increasing the patient’s independence and ability to return to a prior level of function. Rather than medications and, more specifically, opioids, which have a significant risk and often lead to more dependence and have negative side effects, physical therapy moves the patient towards restoring their function and their engagement in physical activities.
UVM Medical Center: How does physical therapy help people function better and treat their pain?
Jennifer Levy: Physical therapy does not mask the pain. It specifically identifies those factors that are contributing to pain. For example, when somebody has an episode of pain, that often causes some fear of pain and some avoidance of activity, so the person limits how they’re moving their shoulder or how they’re walking because of the pain. That leads to secondary problems as well like decreased strength, decreased flexibility.
Physical therapists are trained to identify those physical factors which can contribute to making a patient’s movement painful. That way, they can teach the patient exercises and how to get stronger and move easier so they can engage in and return to what they enjoy doing.
Physical therapy also has other techniques in terms of where we directly try to treat the pain. We do mobilizations of joints and soft tissues, which can help reduce muscle spasm and improve flexibility. We have techniques where we use modalities to also decrease maybe muscle spasm. We can use ultrasound and teach the patient how to use heat and ice to manage their own pain.
Moving itself is shown to help reduce pain, so teaching people how to move in a more appropriate manner, teaching them how to have better posture, all of those things combined to help enable the patient to do more activities without pain.
UVM Medical Center: Tell me a typical patient maybe that you could think who would come in with a certain kind of pain that might impact them in a lot more ways and how you would help them. Just a specific example?
Jennifer Levy: Sure. There’s a wide variety of the types of patients that we see in physical therapy. One would be the patient who has certain acute onset maybe of shoulder pain. Maybe they’ve done something, and now they’re noticing for the first time that they’re having trouble moving their arm because it hurts. That patient would come in, and we do a full hour-long evaluation. We take a detailed history and we test all the systems that go into how that patient is moving as well as what’s producing their pain.
UVM Medical Center: How does physical therapy treat chronic pain? Does it help?
Jennifer Levy: Yeah. Physical therapy and certain parts of physical therapy have shown to be very beneficial in treating chronic pain.
UVM Medical Center: So many people are taking opioids for chronic pain …
Jennifer Levy: It’s not effective.
UVM Medical Center: … and it’s not shown to be super effective, so, for people looking for an alternative, how might physical therapy help? It seems surprising that it would help more than medication.
Jennifer Levy: Physical therapy is beneficial in treating people with chronic pain. People who have chronic pain limit their activities because of the pain. They stop doing the activities that they enjoy. They become more isolated and depressed. They turn to medication, possibly alcohol, other ways of managing their pain and their depression, and all of these things lead to being less active and less engaged in the people in their lives and in the roles they used to have.
Physical therapy is effective because physical therapists have a lot of knowledge about pain. There have been studies that have shown that explaining to patients what is causing their pain helps them deal with their pain and manage it better.
We usually think of pain as indicating that some sort of tissue or structure is being damaged in our body, so, if we step on a nail, we have the feeling, “Oh, I hurt my foot and that’s why I have pain.” With chronic pain, there is not that correlation between tissue damage and the perception of pain. You can perceive and experience pain in the absence of having any tissue damage going on in your body.
For example, someone who’s had back pain, maybe initially they strained their back and they stopped moving. They were afraid to bend forward because that used to hurt, so then they stopped bending forward. This can persist for months, and the patient never bends forward and, when they do bend forward, it hurts, so they stop. This can lead to a state where the patient then has chronic pain, and bending forward hurts even though there’s nothing wrong with their back.
Physical therapists are trained in helping patients experience movement without having the fear of tissue damage because we explain to them that the pain is not hurting them, and then they can move with less fear and get back to their regular activities.
Who might be a good candidate for physical therapy instead of medication?
Jennifer Levy: Anybody can be a candidate for physical therapy. The exception might be someone who has an illness like cancer. Cancer-related pain might not be something that physical therapy can be beneficial for at certain stages, but really anybody who’s having pain and is suffering in some way with regards to not being able to fulfill their daily activities or engage in their life the way they want to be can likely benefit from physical therapy.
What I wanted to mention before was that, in a recent study that came out, it said that most persons with opioid-related deaths were diagnosed with at least one chronic pain syndrome in the last year of their life. These patients would really benefit from being given physical therapy versus taking the medications for a chronic pain diagnosis.
UVM Medical Center: If physical therapy treats pain so well, why do people turn to medication so frequently?
Jennifer Levy: That is a good question, and I think it has a lot to do with the way that those prescription drugs were marketed. Initially, they weren’t marketed as having side effects or potential addictive properties.
When a person is in pain, they don’t want to be in pain and they want a quick fix, and to take a pill is a lot easier than to go to an appointment and do exercises or change the way you’re behaving. It’s a lot easier to take a pill than it is to change your behavior, and it’s unfortunate that, at this point, so many people have been affected by taking those medications.
UVM Medical Center: Do you think that’s changing? I know some of our ER docs have said people are coming and announcing, “What else can I take? Can I not take the opioid?”
Jennifer Levy: I do think it’s changing. I think that the hospital and the health system in general are making stricter guidelines about prescription of opioids. I think that people need to be more proactive in knowing the other options that are available to them.
UVM Medical Center: Is there any new or current research on the topic that is good for people to know?
Jennifer Levy: Currently, the University of Vermont Medical Center is involved in a study regarding low back pain and targeting patients who present to low back pain at their primary care doctors and getting them into physical therapy according to their risk for developing chronic pain. The study is based on stratifying patients according to their risk of developing chronic pain and then matching them with the appropriate physical therapy model.
For those patients who we consider to be high risk, they are matched with a therapist who’s trained in psychologically informed physical therapy that, again, is addressing the biopsychosocial aspects of the chronic pain or even just the back pain experience; whereas, patients who aren’t high risk are either given home exercises or just advised about short-term rest and exercise, and, that way, each person is getting the appropriate amount of physical therapy.
UVM Medical Center: Some people might be intimidated by the thought of coming in for a physical therapy session, and you were mentioning it’s easier to take a pill than kind of go into the unknown and do exercises that you might not know. What does a typical session look like?
Jennifer Levy: All the exercises and all our treatment is individually tailored for the patient. Based on our evaluation, we know where the patient is coming from. We know how fit they are and what they can tolerate, and so it’s not like a one-size-fits-all. Not everybody gets the same exercises and the same treatments.
When a person comes in, for example, if they’re coming for a low back problem, we usually will have them warmed up for a little bit, walking or riding a bicycle, gentle stretching, then some strengthening exercises. We often do education on looking at their posture or looking at how they bend when they’re lifting their child up from the floor. We can give recommendations on how to make those tasks easier.
UVM Medical Center: What do you think is the most important thing for people to know about physical therapy for pain management?
Jennifer Levy: There’s been a lot of research on the benefits of movement and activity in terms of preventing illnesses like obesity and diabetes, and a lot of those problems can lead to chronic pain. The most important thing is movement, and physical therapists are experts in movement. We know all the things that go into being able to move.
For somebody who’s having pain and feels like they can’t move, they can’t go out to dinner and socialize with their friends, they can’t get on the floor and play with their grandchildren, they can’t engage in those activities that give meaning to their lives, they should look to a physical therapist for their advice because our goal is to get them back doing the things that they enjoy and that are meaningful to them.
When you turn the focus and shift the focus to getting back the people moving and getting more involved, you end up decreasing the amount of suffering that they’re doing, and that in turn will likely reduce their pain. Taking the shift away from reducing pain to improving their quality of life in the end makes them feel better.
UVM Medical Center: Our guest today on HealthSource has been Jennifer Levy, a physical therapist at the UVM Medical Center. We’ve been talking about physical therapy as an alternative treatment option for chronic and acute pain.
Thanks for joining us today.
Jennifer Levy: Thank you. It’s been a pleasure.