Chiropractic care, medication and physical therapy offer pain management alternatives. Pain management alternatives eliminate gateways to opioid use or abuse requires finding other ways to manage pain, according to an expert panel at The Alliance’s Opioid Epidemic Summit on July 24,2018 at the Monona Terrace.
The panel on “Alternative Pain Relief” focused on studies that show other types of treatment can manage pain for many patients while reducing or removing the risk of lifelong addiction. These treatments include a non-opioid medication, chiropractic care and physical therapy.
The speakers emphasized that their comments applied to patients with ailments other than cancer, where the use of opioids may be the only way to effectively alleviate pain.
Relief and Pain Management Alternatives After Surgery
A non-opioid medication called Exparel® from Pacira Pharmaceuticals provides pain relief after surgery, which reduces the need to prescribe opioids to patients, according to Janet Poppe, vice president, payer and employer relations for Pacira.
One in 15 patients who receive opioids after surgery become opioid abusers, Poppe said, noting that recent statistics show the percentage who continue using and become addicted is growing.
Exparel is used to numb the surgical site for up to three days, which means Exparel can greatly reduce, or in some cases, eliminate the need for opioids after surgery. As a result, patients who have surgery with Exparel can often begin physical therapy sooner and be discharged earlier.
That means the total cost of care for patients using Exparel is considerably lower compared with patients who use opioids, although it may appear more expensive when only the cost of the medication itself is considered. One study showed average savings of $2,000 per patient on total cost of care when Exparel was used instead of opioids.
Employers can play a role in helping employees understand the advantages of avoiding or minimizing opioid use.
“Educate employees that there are alternatives,” Poppe said. “Help them find providers who use it.”
Poppe shared a list of Alliance Network providers who offer Exparel as an alternative to opioids. Access to Exparel is expected to expand due to a Centers for Medicare and Medicaid (CMS) decision announced on July 26 that enables payment for the use of Exparel at ambulatory surgery centers after Jan. 1, 2019.
Spinal Manipulation vs. Opioids
It’s common for back or neck pain to be treated with opioids. Dr. Jeff King, a chiropractor who represented the Wisconsin Chiropractic Association, said 84 percent of people will have an episode of back pain in their lifetime. Of that number, 15 percent will be given opioids, with 5 percent going on to become long-term opioid users.
“Improving the way spine pain is managed is an important opportunity to prevent opioid abuse,” King said.
One element is changing patients’ expectation that pain can always be completely eliminated.
“It’s important to help patients with chronic pain understand that this may not go away,” King said. Instead, patients need consistent messages and the ability to copy with pain by accessing health professionals with diverse training.
King shared studies showing that spinal manipulation by a doctor of chiropractic medicine reduces pain and disability. He advised employers to consider chiropractic care’s effectiveness when setting limits on the number of visits are covered by the health plan.
“Opioid use is highly variable, but chiropractors and physical therapists have the lowest rate of use when a patient starts their care there,” he said.
Physical therapy can also make a difference in patients’ pain levels. Yet many people do not realize they can directly access a physical therapist without first seeing a physician or nurse practitioner, according to Dr. Kevin Wait, a physical therapist and clinic director with Capitol Physical Therapy in Madison.
Going directly to a physical therapist help patients start coping with musculoskeletal pain more quickly. Wait noted that the U.S. military services routinely direct patients to a physical therapist first for any type of musculoskeletal problem.
Because physical therapy helps people move better with less pain, Wait said it’s a good option for avoiding the use of opioids. A study of 150,000 insurance claims by BMC Health Research showed people were 89.4 percent less likely to get a prescription for opioids if they had physical therapy first.
Physical therapists also play an important role in education patients about pain.
“Pain is more about sensitivity than damage,” Wait said. “Just knowing that lessens pain.”
Self-Funding Plays a Role
Dr. Julie Lombardo, a physical therapist and the owner of Capitol Physical Therapy, noted that a review of patients’ charts showed that only 10 percent of patients who could have benefitted from physical therapy got a referral to a therapist, while 45 percent got an opioid prescription.
Self-funded companies can help change that pattern by altering benefit plan payment for physical therapy, Lombardo said. For example, an employer’s benefit plan could eliminate co-pays for “high value” physical therapy providers.
Employers can also educate employees about the value of seeing physical therapists first and partner with practices to give employees quick access to care.
“As self-funded companies, you have full control over where you want the route of care to go,” Lombardo said. “You’ve got to help us in this fight to eliminate barriers for patients so they don’t head down the wrong path.”