Physiatrists, physical medicine and rehabilitation physicians, and pain management experts call for an expansion of the national focus beyond safer opioid prescribing and addiction management to include a functional approach to both the diagnosis and treatment of pain. A report recently published in the American Journal of Physical Medicine & Rehabilitation (AJPM&R) calls for a comprehensive national strategy to include physical medicine: the expert diagnosis of musculoskeletal and other acute and chronic pain conditions, increased attention to non-pharmacological rehabilitation-based treatments, enhanced funding of pain research that includes functional outcomes, and an expansion in graduate medical education targeted to physiatry.

“We applaud Congress’ recent efforts to reduce the inappropriate prescription of opioids and provide addiction treatment to those affected. However, the legislation does not go far enough; it does not provision patient access to multifaceted pain management programs. We urge Congress to pass additional legislation that would improve access for patients with pain to programs that emphasize improved function rather than merely elimination of pain,” shares Danielle Perret Karimi, MD, associate clinical professor at The University of California Irvine and co-author of the report. “Expansion of graduate medical education to address the opioid epidemic should similarly support training of additional physiatrists: There is no other field of medicine where providers master the assessment and treatment of both pain and function.”

Physiatrists focus on improving the function and quality of life of patients with a wide range of chronic diseases and disabilities. Physiatric management of pain shifts the focus from drug treatments intended to completely eliminate pain to a multifaceted team-based approach that incorporates non-opioid and non-drug treatments, including expert prescriptive exercise programs aimed at addressing physical impairments, the appropriate use of orthotics, the use of the physical modalities and manual therapies and a physician-guided return to progressive activity, mobility and meaningful function.

The report suggests that the response to the opioid crisis must be broader than addiction treatment and opioid prescription limitations. Ending this leading cause of accidental death will require patient access to and reduced costs for non-pharmacological interventions (such as exercise and behavioral therapies), multidisciplinary collaboration among medical providers (to include physiatrists, expert resources in the management of both complex pain disorders and chronic disabling conditions), research funding for non-pharmacological interventions, a call for all pain research to include functional outcome measures, the integration of physiatric principles into both undergraduate and graduate medical education curricula aimed at pain medicine, and an expansion in physiatric residency positions as a targeted national growth investment. AJPM&R is the official journal of the Association of Academic Physiatrists and is published by Wolters Kluwer.