How physiatry is minimizing opioid use at Andrews Institute

Written by Eric Oliver | May 02, 2018 | Print  |

The physically active community is not immune to opioid use but through well-developed physical therapy programs and care coordinated approaches, opioid prescription can be decreased.

Huaiyu Tan, M.D., Ph.D., is a physical medicine and rehabilitation physician specializing in interventional pain medicine at Gulf Breeze, Fla.-based Andrews Institute for Orthopaedics & Sports Medicine. He shared his thoughts with Becker's Spine Review on the prominence of opioids in musculoskeletal medicine, and what he does at Andrews Institute to avoid using opioids for pain management.

While representing only 4.6 percent of the world’s population, Americans consume 80 percent of the worldwide opioid supply. A recent CDC study shows with an initial 10-day prescription, about 20 percent of individuals become long term opioid users.

From this, Dr. Tan said the longer one is on an opioid, the more difficult it is to stop opioid use. Patients prescribed opioids can become tolerant to the effects of the drug, requiring greater quantities to decrease the pain, which in turn contributes to long-term dependence, addiction, and increasing the risk of sudden death.

Dr. Tan said one of the biggest problems is that people become tolerant to an opioid dose and the dose escalates, which creates long term problems.

Most recently in the March 2018 issue of the Journal of the American Medical Association, there was a clinical trial that demonstrated no difference between non-opioid versus opioid treatment groups for back, hip, or knee pain, for over a one year period. Dr. Tan said there are no studies that demonstrate and support the long term effectiveness of opioid therapy.

By being brought into the treatment plan at an early stage, Dr. Tan warns patients of the risks of opioids, including addiction, hormonal disturbance, immune suppression and opioid-induced hyperalgesia. He then develops a proper rehabilitation plan to help the patient recover from injury.

"Physical therapy is the cornerstone of treatment for any musculoskeletal or spine condition," he said. "The majority of my patients are [receptive to physical therapy]. At Andrews, we have a unique clientele where a lot of our patients are motivated to participate [in physical therapy] and are looking forward to returning to an active lifestyle."

As for how other practices can emulate Dr. Tan and the Andrews Institute, he said the biggest thing physicians need to recognize is that all pain doesn't need to be treated with opioids and that pain should not be treated as an opioid deficiency.

"Generating an opioid prescription for pain should be a careful and thoughtful process," he said. "Long-term risk needs to be weighed with short-term benefits. … [And] even when treating acute pain, we need to be judicious."

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