Paul G. Vidal, PT, DPT, is president of the American Physical Therapy Association of New Jersey, APTANJ.
You have said we are experiencing an epidemic of chronic pain. How do you see the connection to the current opioid crisis?
Almost nine in 10 Americans suffer from pain at some point in their lives. About 50 million to about 75 million Americans suffer from chronic pain, reaching epidemic proportions. The reasons for this are many and can be complex. When over-the counter-medication no longer works, people want something stronger. According to the Centers for Disease Control and Prevention, 249 million prescriptions for opioid pain medication were written by healthcare providers in 2013, enough for every American adult to have one bottle of pills! Across the country, more than 40 people die each day due to overdoses from prescription opioids.
Some physical therapists are working collaboratively with mental health providers. How does that work?
There are some physical therapists who treat patients at psychiatric hospitals. As an association, we’re working to strengthen our relationship with mental health providers. We’re scheduled to present at the New Jersey Association of Mental Health and Addiction Agencies Fall Behavioral Healthcare meeting in October.
In mental health centers, there are patients who are being treated for addiction as well as for pain. Physical therapy is part of their overall treatment.
No one discipline can fix the opioid crisis alone. We’re working with mental health providers and educating them about the cross over value of physical therapy and how we should be working together to treat the whole person. In addition to the physical benefits, we know exercise can have a positive effect on mental health. Exercise is a large part of physical therapy and can reduce stress and anxiety, depression, and help people sleep better and improve cognitive function.
Physical therapists offer a safe and effective, non-pharmacological form of pain relief. Physical therapists are an integral part of a multi-disciplinary, collaborative solution to battle the opioid crisis.
You’ve talked about the loop of care that causes health costs for pain to skyrocket. Can you explain that?
Utilization studies have found that the longer a referral to physical therapy takes the higher the total health care cost. Delayed referral to physical therapy for pain often can lead to prescriptions of opioid medications and a string of imaging tests, injections and referrals to other specialists. The cost skyrockets. Some of these things may be necessary, but research shows that a referral to a physical therapist early on can help the individual and reduce the total health care cost.
People generally see a physical therapist after being referred by a physician. But many people in New Jersey don’t know they can call directly to get an appointment and treatment with a physical therapist. How does that work?
Since 2003, New Jersey consumers have direct access to physical therapy services. This means that you can see a physical therapist directly without a physician’s prescription, although some patients may have some insurance requirements to meet, such as getting a referral from their primary care physician’s office. It’s important for people to know they have direct access to a physical therapist and that physical therapist works collaboratively with other health care providers to ensure the best possible outcome for patients. Whether it’s direct access or physician referred, getting people moving sooner rather than later can be of great benefit and potentially avoid opioid medication and other costlier procedures. So I would stress early access to a physical therapist.
So where will we see you on a sunny afternoon when you are not working?
You’ll find me out biking and enjoying the day with my wife and two daughters. If I am not with my family, I am playing golf or doing Crossfit in the gym. My outlets are things I enjoy. I believe you have to walk the walk and be a good role model for patients.