Managing Pain Without a Prescription

The battle against opioid addiction is in full stride. The U.S. surgeon general has launched an anti-opioid campaign and, locally, Middlesex District Attorney Marion Ryan has started the Central South Middlesex Opioid Task Force (which, in full disclosure, I am a member of). Opioid addiction knows no boundaries; it does not discriminate by socio-economics, gender, age, race, religion, or job title.

I admit that I am by no means an expert on opioids and addiction. However, at the Emerson Hospital Center for Rehabilitative and Sports Therapies, we often deal with pain — its sources, its effects on a person’s everyday life, and its treatment. Pain is unpleasant. Pain is usually time limited. It is a response to a noxious stimulant. This goes back to when we relied on our flight or fight instincts for survival. Fire is hot so don’t touch it. Chasing that behemoth is going to leave me with some nasty wounds, perhaps I’ll learn to fish.

Pain can be a good thing; it is part of being human. It is when pain does not go away that it becomes a problem. Chronic pain festers like an infected wound impacting psychosocial, emotional, vocational and physiological systems. Let’s time travel to when I was a kid. I am not old enough to chase behemoths but let’s just say I know what they are. We played outside all day long. We got muddy, we fell off our bikes, we swung from rope swings, we roller skated, we skateboarded, we climbed trees, and we got hurt playing sports. Along the way we collected bumps, bruises, sprains, strains and, yes, a few broken bones.

The favorite prescription of the time seemed to be “walk it off” or “you’ll feel better in the morning”, not because the injury should be ignored, but because there was less of a focus on getting back into the game quickly. Slowly easing into a return to normal activity levels was common practice, and any lingering pain was an indication that you weren’t quite at full strength and more recovery was needed.

Now let’s fast forward to the 21st century. Have you been into a college training room lately? I’ve seen young adults with bumps, bruises, sprains and strains who are taking high doses of pain medication for injuries and pain that would eventually go away with proper rehabilitation and rest.  I know of weekend warriors who load up on ibuprofen prior to any activity. “I’m going to exercise and I might have discomfort so I’m taking an anti-inflammatory just in case.” I ask the question, when did we become a culture that is afraid to feel?

Those minor muscle aches and pains can be a good thing. You’ve exercised, and therefore your muscles are responding appropriately. Yes, sprains, strains, and broken bones need the right dose of prescriptive pain management. In many cases, exercise and physical therapy should be ingredients in the recipe to reduce pain and foster healing. The right dose of physical activity, at the right time, for the right patient has powerful pain management properties.

This is where physical therapists come in. They are experts at movement and exercise to help manage pain, as well as provide individualized recommendations on how to prevent it from returning. The opioid crisis is a complex issue, and no single solution is going to solve it. But finding other ways of pain management besides potentially-addictive prescription drugs might be one way to help slow its growth. Let’s work with our doctors, nurses, and rehab professionals to increase consideration for exercise and rehabilitative therapy as a viable first choice for pain management.