Patients who start physical therapy within 30 days of surgery and have at least six sessions are less likely to chronically use opioid painkillers, a new study finds.
Investigators analyzed health data from more than 67,000 patients with total knee replacement. They found that even relatively low levels of pre- and post-surgical physical therapy were tied to reduced odds of ongoing opioid use.
The type of post-acute physical therapy used did not seem to have an impact on the outcomes, the researchers added. This included active therapy with exercise, or passive therapy such as heating or icing, said researcher Kosaku Aoyagi, Ph.D., of Boston University.
Long-term opioid use was defined as 90 days or more of filled prescriptions during the outcome assessment periods.
Although opioids are not recommended for relieving osteoarthritis pain, the condition is one of the most common for which the drugs are prescribed, Kosaku and colleagues said.
Similar to prior findings, 32% to 35.0% of the study participants in the current study who were already taking opioids also used the drugs after their knee replacement. Among patients who were not prior opioid users, 2.2% to 2.4% used the drugs post-surgery. These numbers are problematic considering the large number of patients undergoing these procedures in the United States each year, the researchers said.
Not all knee osteoarthritis patients respond well to physical therapy, they noted. But the findings suggest that the the treatment could be an effective alternative to steroid shots, nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers, they concluded.
“The future of pain management needs to be a multimodal approach,” researcher Deepak Kumar, PT, Ph.D., also of Boston University, said. “But we’re observing that physical therapy can reduce the odds that a patient will be a chronic opioid user in the future.”
The study was published in JAMA Network Open.
