The Dangerous Cycle of Back Pain and Opioids: Can Physical Therapy Make a Difference?

It’s funny how one nagging pain can take over so much of our lives. If you have experienced back pain, you have become all too familiar with the limitations that chronic pain can bring.

In the US alone, American spend somewhere between $80-100 billion dollars each year on treatments for back pain. Expensive treatments range from medications to injections and complicated surgeries.1

Many people, in desperation for relief, accept prescriptions for opioid painkillers from their physicians. It’s no secret that these powerful narcotics are causing a problem for families across the world. Opioids are addictive, and they are not intended for long-term use.

Opioids work by attaching to brain proteins known as “opioid receptors.” These receptors are located in nerve cells of the spinal cord, brain, gastrointestinal tract and other parts of the body. Once an opioid has attached to parts of the body, our perception of pain lowers.

The relief you feel from opioid painkillers is not actually treating the original cause of the pain, and your body will quickly adapt to the influx of this new drug and stop producing natural painkillers of its own. Before you know it, you become dependent on the opioid drugs for relief.

However, there is an alternative you may not have considered: physical therapy. Even if you have tried physical therapy in the past, new models of treatment are being created every year. New evidence shows that physical therapy may make a difference in your everyday life, and, when combined with other therapies, allow you to set opioids aside for good.

Just How Effective Is Physical Therapy?

New research shows that dedicated, specialized physical therapy can do two incredible things: greatly lower your overall treatment costs and actually improve your pain. Patients who opted for physical therapy first were most likely to avoid opioid dependence in the long run.2

Physical therapists may offer more specialty treatment than your regular family physician, in addition to being able to provide specialized treatment in pain management, muscle and bone biology, and how to best physically support all body movements. Further, licensed physical therapists are required to maintain continuing education in their field, which means that they must remain up-to-date on the latest and most advanced treatments for pain.2

If a physical therapist is unable to treat a patient’s cause of pain, he or she is positioned in the best possible place to offer highly specialized referrals to treatments that can work. Sometimes, physical therapists — not general practitioners — are able to identify problems that run deeper than a “quick fix” of opioid treatment. Because physical therapy is so dedicated to one body system, these clinicians are able to uniquely partner with general practitioners, care management, and even surgeons.2

Why Would Anyone NOT Choose Physical Therapy?

People decide against physical therapy for a number of reasons. In some cases, their insurance providers may make visits financially difficult. Others may not be aware of how effective physical therapy can be, or know that it can also be combined with many other treatments.

In some cases, insurance providers may require a referral from a primary care physician. You may be surprised to find what a good physical therapy treatment team and your primary care provider can do to make insurance understand the need for your treatment.

If opioid dependence has already become an issue in your life, opioid rehab may be the very best first step. Your treatment team can then advocate on your behalf for treatments that are more effective and less addictive.

An Alternative Route to the Slippery Slope of Opioid Dependence

The American Pain Society recommends that all doctors try non-invasive, non-opioid treatment as a first line of defense against body pain, even severe pain. That recommendation is not meant to dismiss the severity of pain.

According to the American Pain Society, steps toward recovery should take the following path:

  • Top recommendation – Patients are encouraged to get a full work-up to understand where the pain is originating. Exams should be thorough and take time to get to the root of the issue. First-line treatments include acupuncture, massage, spinal manipulation and nonsteroidal anti-inflammatory drugs.
  • Second recommendation – The second step to healing includes laser therapy, operant therapy (surgery), progressive relaxation, mindfulness-based stress reduction and electromyography biofeedback.
  • Third recommendation – This is to be used only if the first two recommendations are not effective. More effective, newer, non-steroidal, anti-inflammatory drugs, and other medications such as tramadol or duloxetine may be tried at this point. The absolute lowest-recommended line of treatment is opioid painkillers, and these drugs are only to be used in limited amounts for short periods of time.3

If Opioid Use Has Become a Problem

Once a person has become dependent on opioid drugs for relief, the cycle of painkiller use can be difficult to break. If you suddenly stop using these powerful painkillers, you might feel sick and pain may seem overwhelming at first. The transition to more sustainable treatment doesn’t have to feel terrible. Help is available.

The right rehab program can offer you a medically-supervised detox that will help you overcome this dependence more effectively and with less side-effects. Opioid detox can be supported by your treatment team to ease the emotional and physical symptoms of withdrawal, and treatment after detox can include a thorough assessment or referral to pain specialists who may offer newer approaches to your recovery.


1 Martin B., Deyo R., Mirza S., et al. Expenditures and Health Status Among Adults With Back and Neck Problems. JAMA. 2008.

2 Neighmond, P. Trying Physical Therapy First For Low Back Pain May Curb Use Of Opioids. NPR. 23 May 2018.

3 Qaseem, A., et. al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Internal Med. Apr 2017.

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