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Physical therapy patients may improve faster without opioids

Researchers suggest using a graded approach based on pain tolerance to slowly increase function, rather than using drugs to kill the pain.

By Stephen Feller
Physical therapy patients may improve faster without opioids
Although opioid drugs can be used to effectively kill pain, eliminating too much of that pain hinders physical therapy, according to researchers. Photo by lightwavemedia/Shutterstock

EDMONTON, Alberta, Jan. 22 (UPI) -- Patients who have not been prescribed opioid painkillers benefit more from physical therapy, according to researchers in Canada.

A study at the University of Alberta found patients not taking the powerful drugs for pain while rebuilding physical ability regain function faster.

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The researchers suggest adjusting therapy programs for individual patients' pain tolerance, using a graded approach to recovery by slowly building back to full function.

"Even though opioid medications can be a powerful pain killer, it does not necessarily mean improved function will follow -- pain is not the only factor in determining function," Geoff Bostick, an associate professor of physical therapy at the University of Alberta, said in a press release. "It can be difficult helping people move when they have pain, but as a physiotherapist I know the importance of physical function and we have to help find a way to promote movement, even if it is painful."

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In the study, published in the journal Pain Medicine, researchers followed 789 patients in Canada being treated for neuropathic pain from nerve injuries being treated with either less than 200 milligrams of an opioid, more than 200 milligrams, or none.

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Patients who were not prescribed any type of opioid had statistically lower disabilities and higher physical function scores over the course of 12 months than those who received the drugs, after adjusting for the severity of individual conditions.

Bostick said opioids can be useful for managing pain, though they do not allow some people to recover function, so the drugs interfere with their lives. He suggests patients use careful measurement of their pain tolerance, walking until they reach the halfway point of what they can handle and stop before it gets too bad, in order to build tolerance over time.

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"Pain is very complex, and people experience pain at very different levels," Bostick said. "Opioids can help people with severe pain be more comfortable, but if they are not also facilitating improved function, the impact of these medications on quality of life should be questioned."

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