The epidemic of narcotic medication addiction and abuse is opening the door for a more hands-on approach to treating pain: physical therapy.
Insurance companies have often created a barrier to alternative treatments for pain, limiting the number of sessions patients may get with a physical or occupational therapist, and requiring a prior authorization.
“Some companies limit the number of visits or the number of days a particular treatment option can be billed for,” said Bud Herigstad, an independent physical therapist practicing in Newberg. “Others say no more than five visits for exercise, making potential rehab for certain conditions very difficult.”
Opioid drugs, despite their propensity for abuse, have been given preference, since they’re easy to administer, require little active engagement in health for the patient, and, most importantly, cheaper than physical therapy sessions.
But at least one small Oregon health insurer, Samaritan Health Plans, is working to turn the tide, removing the need for prior authorization for occupational or physical therapy for members of both its Choice Plan and its Medicaid coordinated care organization, Intercommunity Health Network, which serves Corvallis, Albany and Newport.
“It is our hope that this allows more of our patients to access these services,” said Dr. Kevin Ewanchyna, the chief medical officer of Samaritan Health Plans and a member of the Oregon Medical Association’s executive committee.
A recent systematic review and meta-analysis of randomized controlled studies published in the Journal of the American Medical Association showed that exercise, when guided by a physical or occupational therapist, can eliminate or prevent low-back pain, without the need for drugs.
“Many studies now point toward movement therapy and exercise with body conditioning to help improve back pain,” Ewanchyna said. “Physical therapists can provide the training and skill set to help the individual achieve their goals in exercise and movement therapy.”
Ewanchyna said that the provider side of his company -- Samaritan Health Services -- has a work group of primary care doctors and physical therapists searching for ways to improve the patient’s mobility and reduce their pain with less recurrence and less dependence on opioid medications.
The Oregon Medical Association has made opioid, or narcotic, abuse prevention a key goal, both to reverse trends that have proven catastrophic for patients and to bolster the responsibility of the profession. The OMA introduced legislation with Republican Rep. Knute Buehler of Bend, a surgeon who is a member of the organization.
But education and systems reform, including greater promotion of physical therapy, may do more to repel the public health epidemic of opioid abuse and addiction than new or better laws.
Herigstad said that conservative treatment through manual therapy techniques can help at least temporarily with chronic pain and pain exacerbation and sometimes a physical therapist will find a joint malfunction or spinal dysfunction that contributes to the chronic pain and can be treated.
“Establishing and progressing an exercise program can do wonders for pain control, if the person can handle it,” noted Herigstad. “These programs are all individual initially and crafted to the particular needs and limitations of the person.”
