Image from www.moveforwardpt.com
Pros
Now, there are several elements that I agree with in this message:
First, do I think that physical therapy should be advocated for by both PTs/PTAs as well as other health care professionals in terms of managing pain?
Yes.
Second, do I think that medications are over-prescribed or improperly prescribed for issues that physical therapy can treat?
In some cases, yes.
Third, do I think that patients tend to rely heavily on their medications for pain management?
Sometimes! In one of my clinical rotations for school, I worked with a chronic pain population, and some of them did use prescription medications to manage their pain...but a large number of them did not and outright refused to use them. Those that did largely used them as an adjunct or last-resort when symptoms got out of control.
I think that in today's society, we look for the quick fix. How can we do this faster so we can get on with the fun parts of our day? Physical therapy typically isn't the quick fix, especially when it comes to managing chronic pain. We can implement techniques to assist in pain control, but until the patient is able to master these techniques (such as reduce their stressors...which...let's face it, isn't always possible), our methods might need supplementation.
Cons
Now I would like to start the dissenting portion of this review by stating that I truly have no qualms with the message that the APTA is attempting to convey. I actually agree with it wholeheartedly. Why cause more problems (such as drug abuse and addiction) when there are alternative methods to approach the original issue? My true dissent actually lies with the marketing of this idea.From the moment I laid eyes on the image you see above, I was appalled. I found several flaws in this marketing campaign, and I will list them out below.
1) Over-simplicity. The paradigm this picture is presenting is too simplistic. The inclusion of the word "versus" is the real downfall here. In Latin, the word versus means "against." It can also be translated "as opposed to." That makes the two options mutually exclusive from one another, relegating the observer to a choice between one or the other. If I were an average Jane off the street, I might take one look at this picture and think "great, once I start therapy, I don't have to take my medications anymore." Now, while we did not directly instruct them on this, our marketing led them to believe that they can have drugs OR therapy, but NOT both. This can be inherently dangerous with some medications such as mood stabilizers or those used for controlling blood pressure. Additionally, patients in the acute stages of injury might require pain medications to participate in therapy services. I haven't seen many patients in the acute care setting who can participate in PT without medication before hand. Now while this campaign was created in relation to chronic pain, the word "chronic" is no where to be found, feeding into the continued theme of over-simplistic delivery. This simplicity delivers an unknowing ultimatum to the community, which I don't quite think was the intention of the APTA.
2) Scope of Practice Issues. It insinuates that PT somehow manages addiction. Quite a bold move from a group of people that can't even suggest an NSAID. Now, while we can assist in the process and recovery of substance abuse and addiction (PTs do work in behavioral health hospitals), we don't actually assist in the detox process. Last time I checked, prescribing medications is out of our scope of practice. We can't give drugs, change the dose, or even suggest that they stop taking a medication (unless a medical emergency is occurring in which we call 911 to get an ER doc to make that call). What we can do is call the doctor on the patient's behalf and discuss our findings, encourage honest communication in the patient/physician relationship, or offer resources to our patients. This picture suggests that we can do much more than that due to its facile nature. I can't think of many other ways to get the AMA riled up faster.
3) Demonization of Medication Use. Now I understand that this poster is related to Opioids, which are highly addictive and dangerous. They are considered to be a Schedule II narcotic, which is the second to most dangerous class of controlled substances. (For Reference: Schedule I are drugs that have no medicinal purpose, such as LSD, and are used only in strictly-regulated lab research.) It's super nasty stuff. However, I would like to point out that there is no mention of opioids in this picture. For all the common person knows, these could be Tylenol or Aspirin. Does that mean that our patients shouldn't take their daily aspirin and that some stretching could prevent their impending heart attack? Obviously not, but do I want to be the person in charge of this marketing when the APTA is taken to court and sued over false advertisement? Obviously not! Again, we are led back to the original theme of over-simplification.
Furthermore, not only was this posted on the internet, but it was also blasted all over Times Square as a publicity stunt for the world to see. I would like to point out, however, that the APTA is not the only organization to be doing this. The Partnership for a Drug-Free New Jersey also posted this equally disturbing, but somewhat more extreme sign as well.
Drug addiction is a serious and complex societal issue, and while I understand that marketing typically needs to be quick and snappy, I feel that the APTA missed the mark(-eting) on this great opportunity for advocacy and change. While I will continue to support the role of physical therapy in pain management, I will not defend the way it is being marketed.
The opinions reflected in this blog post are not representative of the views of the APTA, the CDC, or any other organization mentioned in this post.
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