Unless you do not reside in the United States and/or live under a rock, you likely have heard of the opioids epidemics affecting all parts of the country and all social classes.
It's start with a patient visiting their doctor because they have acute or chronic pain. For various reasons ( time constraint induced by healthcare system( another topic on its own), lack of assessment skills for this specific problem, ...), this patient and their physician decide to go for the easy band-aid solution: an opioid prescription is written and this patient is immediately on their way to the pharmacy, with high hopes that they will be back to 100% in just a few days...
No other alternative were discussed to address this pain and since the physician did not bring it up, the patient thinks it is also likely the best way to address their complaint...
And so could start the downward spiral of an opioid addiction...
After 3 days, 3 weeks, 3 months or 3 years, this patient might still be filling their monthly prescription of opioid. At this point, it is most likely they are dependent... With no sign of improvement on the horizon...
In these days and age, it is inconceivable that this is happening in a country like the States. We are in no way lacking in public information, medical advancements, alternative treatments and options when it come to address pain. Are we lacking in good practitioners that know how to help patients without making them dependent on pain pills? I don't think that is the case either. They are plenty of these. They just need to be found. In today's environment, patient SHOULD be shopping for good medical providers. They exists...
Some feathers will be ruffled by saying this but, health care is like any other business. There are good businesses and some bad ones...
And I would put medical providers that systematically prescribe opioids as their first line of treatment in that category. There exists many approaches to deal with acute of chronic pain, medically or naturally, that should be used first before ever considering opioids. Opioids can have their place in some post surgical and very specific conditions, but in general, musculoskeletal problems are certainly not one of them.
The public opinion is starting to wake up to the fact that since the nineties, opioid have been seriously overprescribed, creating a generation of addicted patient. For comparison, Oxycodone, Hydrocodone, Vicodin, Norco, Dilaudid, Fentanyl and the likes are just derivative and share the same molecular compositions as opium, heroin, morphine...They also share some effects and side effects.
Last summer, the Surgeon General sent the letter below this paragraph to all physicians in the United States...As the US alone accounts for >85% of opioids use worldwide...And that has been the case since the 90's when these drugs came in force on the market and big pharma advocated their use to every single physician's office in the country.
The long term side effects are now known...and it ain't pretty. Some entire communities are affected by opioid addiction and in some localities, this addiction has contributed to a rise in heroin and intravenous drugs consumption...with this also increasing the spread of HIV and Hepatitis C.
All of this to weigh in on this epidemics and give my two cents... as I have seen first hand the dramatic effects it can have on patients in my 15 year career.
If you injure yourself and get hurt, visit a doctor and are first prescribe opioid, I would highly suggest that you question this decision, discuss it thoroughly and ask your physician for any other alternatives first.
For any musculoskeletal diagnosis or problem that involve mobility and movement, such as back, neck and limb pain, as well as chronic headaches or headaches, I would consult with a physical therapist first, unless of course you find yourself in a medical emergency type situation of course.
Physical therapists ARE trained in differential diagnosis and will refer you immediately to a physician if they find you need immediate medical attention or presents with a suspected diagnosis that they cannot address. In most cases, it is likely you will not need to see a medical doctor.
So be an informed and smart patient! Take control of your own care when it comes to your health. You are your best advocate.
Pierre-Yves Butheau, MPT, CMP has been a physiotherapist for 19 years and has a passion for helping people move better, return from and prevent injuries, as well as improve their function and quality of life. He has a strong interest in addressing the root cause of and treating neuro-musculoskeletal conditions while educating his patients with the knowledge to manage their conditions and prevent recurrence. Pierre also has a niche in treating Bell's palsy and temporomandibular joint dysfunctions.