While the debate rages on regarding the solution to the opioid crisis, the fact remains that it is simply cheaper and easier for patients to take these medications than it is to try alternative therapies. Patients often complain that physical therapy is too expensive because they have to pay a copay every time they go (therefore paying three copays a week versus one a month for their opioid prescription). Physical therapy also requires a time commitment of 30 to 60 minutes two to three times per week. Additionally, many medical procedures that can fix the cause of the pain rather than just masking it are not even covered to begin with.

Treatment Options

According to physical medicine & rehabilitation specialist (PM&R) Mahmud Ibrahim, MD, “It’s frustrating when I have a patient who refuses to try anything for their pain other than opioids. I cannot tell you how many patients I treat who come in and will not accept any form of treatment other than an opioid. Granted, many of these patients have tried therapy, injections, and possibly even surgery in the past and nothing gave them sustained relief. However, when I ask if they continue to perform their home exercise program, almost all of them admit that they aren’t. In addition, there are a lot more injections that interventional pain physicians can perform other than the bread and butter epidurals, trigger point injections, and radiofrequency ablations. I would encourage physicians to seek some assistance from a pain specialist when dealing with chronic pain patients. At the very least, we may be able to help reduce the patient’s opioid dose.”

The U.S. is a nation in crisis and in pain. We need to both do a better job treating pain while at the same time decreasing the number of opioid prescriptions being written. Allowing patients’ pain to go untreated is not an option. Third-party insurance companies must start paying for more of the services that reduce or eliminate pain without the need of opioids. Additionally, providers and patients both need to be educated on these options. What good is it to have them available and no one even knows about them?

As new regulations are implemented, doctors must arm themselves with as much information as possible to address pain. Additionally, communication must be improved between specialists, such as between primary care doctors and PM&R specialists, to ensure we are all on the same page when treating these patients.

  • Linda Girgis, MD, FAAFP

    Linda Girgis, MD, FAAFP, is Owner of Girgis Family Medicine LLC. Currently affiliated with St. Peter’s University Hospital and Raritan Bay Hospital, Linda also writes for Sermo, Physician’s Weekly, the Library of Medicine, and others.

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