A Call to Action: How Physical Therapy Can Address the Opioid Crisis

Introduction

The opioid crisis has become a significant public health issue, with over 100,000 overdose deaths recorded in 2022 alone.¹ While opioids can be effective for managing acute pain after serious injury or surgery, they are easy to misuse and not effective for long-term pain management.

Physical therapy (PT) offers a safe, effective alternative to opioids by treating pain at its source and improving long-term function. By addressing movement dysfunction, muscle imbalances, and nervous system sensitization, PT helps patients regain mobility and reduce their reliance on medication.

1. Understanding the Link Between Opioids and Chronic Pain

Opioids work by binding to receptors in the brain and spinal cord to block pain signals and release dopamine, creating a powerful sense of relief. However, prolonged use can lead to tolerance, requiring higher doses for the same effect, which increases the risk of dependence, addiction, and overdose.²

Opioid-Induced Hyperalgesia: When Opioids Make Pain Worse

Over time, repeated opioid exposure can lead to opioid-induced hyperalgesia (OIH)—a condition where the nervous system becomes overly sensitive, and even mild stimuli are perceived as painful. Instead of dulling pain, opioids may worsen it. This can lead individuals to use higher doses, increasing the risk of overdose and reinforcing a cycle of drug dependence.

For many conditions, such as low back pain, osteoarthritis, and post-surgical pain, opioids are often prescribed without addressing the mechanical and neurological causes of discomfort. This can prolong the pain experience and hinder recovery.

2. How Physical Therapy Provides an Alternative Solution

Physical therapy is an evidence based, non-invasive approach to pain management that targets the root cause of pain instead of just masking symptoms. Key PT strategies include:

Pain Neuroscience Education (PNE)

Patients learn how pain works in the body, helping reduce fear and anxiety. Understanding that pain is not always a sign of tissue damage empowers patients to move with greater confidence.

Exercise Therapy

Personalized movement programs build strength, enhance flexibility, and restore joint function, naturally reducing pain.

Manual Therapy & Dry Needling

Hands-on techniques like joint mobilization, soft tissue massage, and dry needling help release tension, increase blood flow, and improve mobility without medication.

Mind-Body Approaches

Incorporating practices like breathwork, yoga, Pilates, and mindfulness enhances the body’s stress response and improves overall pain regulation.

Graded Exposure Therapy

Gradually reintroducing movement in a controlled and comfortable way helps patients reduce fear of movement and restore function over time.

3. Research Evidence Supporting PT as an Opioid Alternative

Numerous studies support the effectiveness of PT in reducing the need for opioids:

• A 2018 study in JAMA Network Open found that patients with neck, shoulder, low back, or knee pain who received PT within 30 days of diagnosis were 10% less likely to use opioids long-term.³

• A study in The Journal of Orthopedic & Sports Physical Therapy found that PT is more effective than opioids for reducing pain-related disability.⁴

• The CDC’s 2022 clinical guidelines recommend PT as a first-line treatment for chronic pain before considering opioids.⁵

4. When to Choose PT Instead of Opioids

PT is particularly beneficial in the following situations:

• Acute musculoskeletal injuries (e.g., back, neck, shoulder, and knee pain)

• Pre-surgical rehabilitation (Prehab) to improve post-op outcomes and minimize opioid use

• Chronic pain conditions such as fibromyalgia, osteoarthritis, and post-surgical pain

• Transitioning off opioids with active rehab to retrain the nervous system and restore function

5. Policy and Systemic Changes to Promote PT Over Opioids

To prioritize PT as a frontline treatment, systemic changes must include:

• Expanding insurance coverage (including Medicare and Medicaid) for PT services

• Educating healthcare providers about PT’s effectiveness and safety

• Raising public awareness of non-drug alternatives for pain relief

• Encouraging interdisciplinary collaboration among physicians, physiatrists, and physical therapists

Conclusion

Physical therapy offers an evidence-based, long-term solution for pain management that reduces the need for opioids. By addressing the root causes of pain through movement, education, and manual therapy, PT empowers patients to take control of their health without relying on addictive medications.

If you or someone you know is struggling with pain and considering opioids, consult a physical therapist to explore safer, more effective treatment options.

References

1. National Institute on Drug Abuse. Drug Overdose Deaths: Facts and Figures. National Institute on Drug Abuse website. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. Published August 21, 2024. Accessed March 29, 2025.

2. National Institute on Drug Abuse. Prescription Opioids DrugFacts. National Institute on Drug Abuse website. https://nida.nih.gov/publications/drugfacts/prescription-opioids. Published June 1, 2021. Accessed March 29, 2025.

3. Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open. 2018;1(8):e185909. doi:10.1001/jamanetworkopen.2018.5909

4. Mintken P, Moore J, Flynn T. Physical Therapists Role in Solving the Opioid Epidemic. JOSPT. 2018;48(5). doi:10.2519/jospt.2018.0606

5. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;71(No. RR-3):1–95. doi:10.15585/mmwr.rr7103a1