Opioids and Pain Management
For the past two decades, Canadians have been told that prescription opioid medications are safe, effective, non-addictive solutions for acute, chronic and persistent pain. The use of prescription opioids has grown in Canada and has now reached a crisis level. Canada is the second largest per capita user of prescription opioids in the world. Lack of access to physiotherapy and interdisciplinary pain care is an important contributor to this crisis.
Physician prescriptions for opioids have become the first line of defence for pain management in the last 20 years. The crisis itself has been driven by the marketing of the pharmaceutical industry, despite limited evidence for the efficacy of these drugs for musculoskeletal pain. In fact, opioids have not demonstrated a clinically important change in pain level for many people with pain. In contrast, there is evidence of clinically important effects for physiotherapy, exercise and interdisciplinary care for people with complex pain problems—but people living with pain and their primary care providers often don’t have access to effective pain management and conservative non-pharmacological therapies.
The answer to this crisis can be found upstream. Simply put, the first prescription for opioids to treat acute musculoskeletal pain needs to be prevented. Prior to any opioid being prescribed, conservative pain management, including physiotherapy, needs to be optimized.
The federal government is leading a National strategy to address the opioid crisis, which has resulted in a joint statement of action.
How Physio Can Help
As the federal Minister of Health commits to supporting better prescribing practices and better treatment options for patients, the Canadian Physiotherapy Association is committed to:
Reviewing the draft Canadian Guidelines for the Treatment of Non-Cancer Pain
Increasing access to pain education for CPA members in collaboration with the Pain Science Division
Developing evidence-based professional practice recommendations and guidelines to facilitate the appropriate triage and referral of Canadians suffering from chronic and acute pain
Promoting the use of eOMs to provide valid functional outcome measures for patients and care teams
Using evidence to demonstrate the effectiveness of physiotherapy and conservative management of musculoskeletal pain
Promoting a public campaign during National Physiotherapy Month to bring attention to the role of physiotherapy in pain management
Partnering with the other organizations to advance education and access to interprofessional multimodal pain management.
Call to Action
To help promote the message that physiotherapy is a safe, effective alternative to opioid prescription, there are several things that you can do to help.
Be informed: For many of us, pain management was part of our entry-level program, but we may have done little to improve our skills since then. Become familiar with the current evidence on pain mechanisms and pathways. Read the latest research and keep yourself current in pain management. Pain is one of the main reasons that people seek physiotherapy, so we need a membership that is engaged and informed. Stay tuned for education and resources for patients and members.
Become a member of the Pain Science Division: Members have access to PSD newsletters, podcasts and blogs. This is knowledge mobilization in action- information is presented in understandable language and can be easily incorporated into your existing practice.
Reach out to your provincial/territorial branch: Your branch staff and volunteers are perfectly positioned to advocate to their provincial/territorial governments on your behalf. Health care decisions are made at this level, and your branch leadership can help promote the need for improved access and funding for physiotherapy.
Watch for the advocacy toolkit: Our members need to reach out to their elected officials with messages about pain management and physiotherapy. The Practice and Policy Team at CPA is working to develop these tools to share with you on the website. The tools will help you to plan your correspondence or conversation with your provincial or federal representatives.
- Self Assessment Tool
- Self Assessment Tool - Resources by Competency
- Fact Sheet: Physiotherapy - A Safe Alternative to Opioids for Pain Management
- Fact Sheet: How Physiotherapists Manage Pain
- Fact Sheet: 5 Tips to Avoid Chronic Pain
- Fact Sheet: 9 Things You Should Know About Pain
- Letter to Jane Philpott
- CPA/APTA Joint Statement
- Physiotherapist's Role in the Opioid Crisis (pdf)
- Joint Statement of Action to Address the Opioid Crisis (Government of Canada)
- APTA Campaign Toolkit
- The Value of Physiotherapy - Low Back Pain
- The Value of Physiotherapy - Musculoskeletal Conditions
- CPA Responds to the Opioid Crisis - PABC Directions article, May 2017 (pdf)
- CPA Response on Pain Guidelines, May 2017 (pdf)