Early Physical Therapy May Reduce Opioid Use for Musculoskeletal Pain

Musculoskeletal pain is estimated to affect nearly half of adults in the United States. Since pharmacologic treatments for chronic musculoskeletal pain can often include opioids, many of these patients may have an increased risk of future persistent opioid use.


However, a new study suggests that initiating physical therapy early-on among patients with musculoskeletal pain may be tied to reduced chronic opioid use subsequently, as well as lower-intensity opioid use.

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These findings are encouraging, according to researchers. As the opioid epidemic continues to plague the United States, non-pharmacologic interventions for musculoskeletal pain have become increasingly important.


“Because musculoskeletal pain is a very common condition, there’s a concern that people will transition to longer-term opioid use. What we found is that, if we can get these patients to physical therapy early, it can reduce their risk of long-term opioid use,” said lead author Eric Sun, MD, PhD, of the Department of Anesthesiology, Pain, and Perioperative Medicine at Stanford University School of Medicine, in an interview with Consultant360.


Dr Sun and colleagues arrived at their conclusion after conducting a cross-sectional analysis of private health care insurance claims data from January 1, 2007, to December 31, 2015 from men and women aged 18 to 64 years who were privately insured.


All 88,985 opioid-naïve participants in the study sample had presented to an outpatient physician office or an emergency department and had received a new diagnosis of musculoskeletal shoulder, neck, knee, or low back pain between January 1, 2008, and December 31, 2014.


Of these patients, 26,096 (29.3%) received early physical therapy, or at least 1 session that was received within 90 days of the index date (the earliest date a relevant diagnosis was available).


Ultimately, adjusted results of the study indicated that early physical therapy was associated with a statistically significant decrease in any incident opioid use between 91 and 365 days following the index date for patients with:


  • Shoulder pain (odds ratio [OR] 0.85)
  • Neck pain (OR 0.92)
  • Knee pain (OR 0.84)
  • Low back pain (OR 0.93)


Among patients who went on to use opioids, early physical therapy was found to be associated with an approximately 10% statistically significant decrease in their amount of opioid use (measured in oral morphine milligram equivalents) for:


  • Shoulder pain (−9.7%)
  • Knee pain (−10.3%)
  • Low back pain (−5.1%)


However, the decrease in opioid use was not statistically significant for neck pain (−3.8%). Determining why early physical therapy may be effective for some types of musculoskeletal pain but not others will be an important area for future study, Dr Sun and colleagues wrote.


The early physical therapy intervention likely also warrants further study in a randomized controlled trial and in other populations, such as elderly patients and Medicaid beneficiaries, Dr Sun told Consultant360.


—Christina Vogt



Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of early physical therapy with long-term opioid use among opioid-naïve patients with musculoskeletal pain. JAMA Network Open. 2018;1(8):e185909. doi:10.1001/jamanetworkopen.2018.5909.