New research examining 88,985 opioid-naive patients with shoulder, neck, knee, or low back pain has found that early physical therapy (PT) could steer patients away from opioids.
Exercise Decreases Opioid Use?

The study, “Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain,” appears in the December 14, 2018 edition of Anesthesiology.
Co-author Eric Sun, M.D., Ph.D., with the the Stanford University School of Medicine in California told OTW, “This topic was of interest to us given the growing awareness of opioid use in the United States and recommendations that non-pharmacologic alternatives (e.g., physical therapy) be used instead of (or in addition to) opioids to manage pain conditions.”
The authors found that early PT was associated with approximately 10% reduction in subsequent opioid use.
“Our most important result,” Dr. Sun told OTW, “is that early physical therapy is associated with lower long-term opioid use among patients with severe musculoskeletal pain. Patients with severe musculoskeletal pain (and their healthcare providers) should seek physical therapy as soon as is possible.”
“Our research is one the few large-scale studies to suggest that physical therapy can provide a statistically significant benefit (in terms of long-term opioid use) for patients with severe musculoskeletal pain, and suggests that physical therapy can play an important role for these patients.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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