Battling opioid addiction through exercise

Physical therapists using exercise to help those suffering from chronic pain

A.J. Lievre, director of education at Woodstock Rehab and Fitness, works on a patient at the physical therapy facility. The center uses exercise as a prescription for people suffering from chronic pain. Rich Cooley/Daily

Physical therapists are combating chronic pain with exercise, in place of addicting opioids.

David Reichley, owner of Woodstock Rehab & Fitness, said they have been open for 17 years and have used exercise as a prescription for people suffering from chronic pain.

“We practice a unique method in that you see the physical therapist for 30 minutes and then a physical therapy assistant who usually takes a person through their therapeutic exercises. So you see a physical therapist every visit,” he said. “That’s not the most efficient way, but you get the best results that way. When I explain it to people, I add the phrase: it would be how you want your mother treated.”

A.J. Lievre, Woodstock Rehab & Fitness director of education, said many of the patients they see are often on a “laundry list of pills,” depending on their condition.

“We treat a lot of patients with persistent pain or chronic pain that they’ve dealt with for a long time,” he added. “When they’ve dealt with pain for a long time they often get medications that are attempting to mitigate their pain, but one of the biggest problems with opioids is that opioids have been shown to not be effective in treating chronic pain, despite the fact that many of our patients who are dealing with chronic pain are still on opioids.”

When a person gets injured, we go through a period of healing, he said. The body heals itself and after six to eight weeks, the damaged tissue has healed.

“The problem is that people continue to have pain after that,” he said.

Opioids block the pain message from getting to the brain, but they aren’t effective in doing that with patients with chronic pain because there are a lot of other factors that are involved, including physical, emotional and psychological.

“I think that’s one of the reasons why physical therapy is helpful,” he added. “Patients with chronic pain usually have very high sensitivity levels. They are dealing with a very sensitive system and what we’re trying to do is decrease their sensitivity levels through exercise and through pain education. That seems to be more effective than pills.”

Some of the commonly prescribed opioids are Percocet, OxyContin and Vicodin, Lievre said, and they come with terrible side effects and addictive properties.

“If they really worked, why are these people still in pain?” he added.

When he asks patients if their medication works, they are uncertain, but say they can’t do without them because they are worried about experiencing more pain or are addicted to the medication.

He said it is not his role to tell people whether to continue or discontinue medication. Staff asks  patients what their goals are and if their goal is to stop the medication then they are advised to speak with their primary care doctor and then use exercise and pain education to decrease their sensitivity levels.

It’s not easy to break a habit, he added, especially when there are both physical and psychological components to it. Patients also expect the physical therapist to move their muscles for them and have a “fix me attitude” that isn’t helpful in patients dealing with chronic pain.

“They need to take an active role in their care,” he said.

When he tries to explain how to overcome pain, he uses a wrist analogy. If you sprain your wrist and decided to hold and clench your fist for six weeks, how badly do you think your wrist would hurt after that? It would hurt worse because of all the compression and muscle tension. And then he tells patients to think about trying to get their wrist moving again and open it up. It would initially be difficult, but once you got it moving around, it would start to feel better. This analogy is to help them to get out of their guarded mindset.

The most common injuries they see with people using opioids are low back pain, he said. One in three people in the U.S. suffer from chronic pain and about 25 percent is low back pain, followed by neck pain.

“The spine is scary to people. It’s more of an unknown,” he said, because we can’t see our spines, but we can see their other joints and protect them better.

He added that the fact that people are imaged so often, it can lead to fear if they find out they have an abnormality, even if it’s minor, and many people have the same conditions.

Lievre said they screen for musculoskeletal problems, but if they hear concerns regarding anxiety or depression, they bring in other health care professionals in those fields to assist and make the process a team approach to help the patient.

“One of the highest predictors of developing chronic back pain is depression,” he added.

Jennifer Carter is medical director of Winchester Rehabilitation Center, a 30-bed inpatient comprehensive rehabilitation hospital, and is board certified in physical medicine and rehabilitation, which is a specialty known as physiatry.  She said increasing activity tolerance and endurance and enabling weight loss can lessen pressure and impact to the joints.

“Physical therapy and exercise can prove to be a vital role in assisting in decreasing chronic opioid use,” she said. “There has been good evidence supporting the positive outcomes of therapy in response to back pain, knee and hip osteoarthritis pain and fibromyalgia.”

Carter said for someone to become addicted to a medication or ween themselves off an addictive medication varies depending on family history, the type of pain they are feeling and the addictive traits of the medication. Dependence can occur after a relatively short duration of use.

“Our society sometimes prefers to take the path of least resistance both as physicians and patients,” she added. “This is what leads to an opioid epidemic.”

Physician support is vital to providing support to those wanting to get off a drug, but she added that physicians can also be part of the problem of chronic opioid use.

“As physicians, in terms of patient satisfaction, there’s a push to keep patients happy. Giving them the quick fix and continuing sort of indefinitely to maintain patient satisfaction or not being aware of alternative treatment or losing sight of the bigger picture of what the effects of chronic opioid use is,” she said.

She said patients often prefer medication because alternative treatments, such as physical therapy, exercise, and even acupuncture, take longer to manage pain, versus taking a pill.

“I don’t think most people fully understand the risk of chronic opioid use, instead they’re focusing on the immediate gratification, escape from reality, even avoidance of acceptance from their personal obligations to their own health or just waiting for health care professionals to intervene and decide to stop the medication instead of them also being proactive,” Carter added.

Risks of chronic opioid use include hormonal disruption, testosterone depletion, hyperalgesia (opioid- induced increased sensitivity to pain), decreased libido, decreased energy, risks of overdose and respiratory depression with increased opioid tolerance, she said.

But there is a role opioids have in several populations, she added, and need to be available when appropriate, such as in cancer-related pain syndromes.

“The heart of the issue is that we need to be determining when opioids are needed for true chronic pain that won’t be amendable to alternative treatments versus pain that stems from mechanical or behavioral roots that require lifestyle modifications, therapy and modalities over chemical numbing.”