How Physical Therapy Techniques Can Help Reduce Opioid Use

If you’re recovering from a serious injury or surgery, or managing chronic pain, you might be prescribed an opioid. Opioids help block pain messages sent from the body through the spinal cord to the brain.

Opioids are a class of drug that includes some illegal drugs, such as heroin, as well as legal prescription drugs like oxycodone and morphine. And in recent years, the United States has seen a startling increase in substance use disorders that were a result of an opioid prescription to treat pain.

When someone becomes addicted to opioids, their brain and body start to believe the drug is needed to survive. Many physical therapists work to intervene in a patient’s recovery to reduce the need for prescription medication. They have found that some techniques can be very effective ways to bring physical and emotional relief during recovery from injury or illness — or even from opioid withdrawal itself.

Understanding Opioid Withdrawal

While physical therapy can be used to limit the need for prescription painkillers, massage and acupuncture therapies have been proven to increase dopamine and serotonin and decrease cortisol, which can help those in recovery.

Dopamine and serotonin are two neurotransmitters that play an important role in the brain and gut. Dopamine regulates mood and muscle movement and is key to the brain's pleasure and reward systems. Unlike dopamine, the body stores the majority of serotonin in the gut, instead of the brain. Serotonin helps to regulate mood, body temperature and appetite.

Cortisol is a stress hormone that decreases serotonin and dopamine. Symptoms of too much cortisol include excessive weight gain, weak muscles, high blood pressure, a tendency to bruise easily, and slow wound healing.

In the early stages of withdrawal from opioid addiction, when dopamine often drops significantly, this can be a very uncomfortable time.
When someone in recovery is stressed, it can bring on mood disorders, including depression. The body pumping out so much of the stress hormone, cortisol, can eventually alter the balance of neurotransmitters. They deplete dopamine, decreasing happiness; reduce norepinephrine, leading to a lack of motivation and alertness; and lower serotonin, reducing feelings of happiness and well-being.

Breaking the Cycle With Physical Therapy

Justin Talbott, AdventHealth physical therapist, explains that it is becoming more recognized that physical therapy has a key role in the fight against opioid addiction. “Therapists have the training and experience to educate the patient on chronic conditions, which would include setting realistic expectations for recovery and working directly with them to achieve their goals,” Talbott says.

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report." For pain management, the CDC recommends physical therapy for recovery rather than prescription opioids to help break the cycle of opioid dependence developing after they are prescribed for pain.

Injuries such as low back pain, knee osteoarthritis and fibromyalgia have been backed by “high-quality evidence” supporting the benefits of physical therapy for those conditions.

Talbott adds, “It is important to understand that physical therapy should be combined with low, effective opioid dose treatments or physical therapy alone to help break the cycle of pain dependence.”

Finding Support With Massage Therapy

When someone has become addicted to opioids and they are working on breaking that addiction, withdrawal symptoms start to set in. Managing cravings, nausea, mood swings, pain, agitation, anxiety and sleep problems can be incredibly challenging.

“Massage therapy — nearly any kind of massage — helps with all of these side effects,” explains AdventHealth licensed massage therapist Alisa Willman, adding, “We’re able to tell our clients, ‘This is what relaxation feels like.’ Someone puts healing hands on you, and suddenly you become aware. Often people say, ‘I never knew I was that sad/happy.’”

“The body releases fewer stress hormones when being massaged. Stress hormones, including cortisol, weaken the immune system and can lead to increased pain. This becomes a vicious cycle, one that massage can help break,” Willman adds.

Massage helps with overall relaxation by stimulating pressure receptors, which enhance vagal activity. Since the vagus nerve is one of the 12 cranial nerves in the brain, this decreases heart rate, lowers blood pressure and decreases stress hormones. “You will sleep better and be less anxious. It’s a whole chemical reaction that is happening,” Willman says.

Willman describes the importance of massage therapy for helping people who are in recovery from opioid addiction heal: “When someone has an opportunity to be touched, to have therapeutic work on their body, it can bring their recovery to a much deeper level. When you bring someone back to their body, it’s like bringing them home.”

Acupuncture Therapy Support

Emily Mammone, doctor of Oriental Medicine and licensed acupuncturist shared that acupuncture has been proven to effectively treat and manage all types of pain conditions: “Patients are commonly able to reduce the use of opioids for pain due to acupuncture decreasing their overall pain levels,” she explains.

Acupuncture has been proven to increase patient retention in drug treatment programs, reduce anxiety and cravings, improve sleep and enhance mood, helping patients to be more optimistic about their recovery journey.

“We use the National Acupuncture Detoxification Association (NADA) acupuncture protocol, which is specific for drug addictions. It is the insertion of tiny pin-like needles into the ears. The ear is a powerful micro-system used to treat the body systematically. The needles are left in the ears for 30 to 45 minutes, typically in a supportive, relaxing and nonverbal group setting,” Dr. Mammone says.

Dr. Mammone shares that she has a patient who is a veteran and has been suffering with neck, shoulder and low back pain for over 20 years. “This patient was on opioids for his pain for those 20+ years, which he states ‘made him feel like a zombie,’” she recalls. His quality of life was extremely poor. He was either constantly in pain or "zonked out" due to the opioids. He went to an opioid addiction clinic twice in order to try to successfully get off of the opioids, but sadly would always resort back to opioids due to his pain.

But after one acupuncture treatment with Dr. Mammone, his pain was more than 50% reduced. “His pain levels have now decreased by 80% and remain at this level with acupuncture maintenance care once per week,” she says. “He is a senior citizen and is going back to school to get another degree because he finally feels the energy and motivation to do so — something he had always wanted to do!”

Healing with AdventHealth

We’ll help you find an effective treatment plan that is unique to you and supports your whole health. We advise patients to follow the prescribed medications and recommendations of their doctor, in addition to the care that their physical therapist provides. To learn more about our therapy programs and to make an appointment, call Call407-303-8080.