Is Physical Therapy a Realistic Alternative to Opioids for Treating Chronic Pain?

Taking a pill to ease chronic pain is easy, at least at first. But it comes with side effects – the most well-known of which is probably addiction. One alternative to opioids for chronic pain is physical therapy.

“Side effects of physical therapy are less pain, improved movement, improved function,” said Carrie Abraham, president of the West Virginia Physical Therapy Association. “So they’re all positive side effects versus with the opioids we have those negative side effects of dependency and addiction.” Abraham is one of almost 1,500 active physical therapists in West Virginia. She said although there isn’t exactly a lack of physical therapists in West Virginia, transportation can still be an issue. West Virginia is highly rural after all. But the bigger issue is insurance coverage.

“Now we have insurance companies that are limiting access to physical therapy care,” she said. “They’re limiting the number of visits directly in some cases, but then they also are limiting access by the amount of copay and coinsurance that patients are required to pay. So depending on their financial status they might not be able to afford to attend physical therapy visits multiple days a week.”

Ok this is by no means scientific. But I emailed PEIA and they said they didn’t have a cost breakdown of covering physical therapy versus opioids. So I called a physical therapy office and a pharmacy to see what they charge insurance for one PT visit versus one bottle of oxycodone.

The answer? It really depends. The cash price for one 30 day supply of oxycodone at one 10 milligram pill a day is $32.99. That price would change based on how many milligrams each pill contains. The cash price for one physical therapy visit at the Charleston clinic contacted by West Virginia Public Broadcasting is $50.

However, that’s only if you are paying cash. If you run the visit through your insurance company then you’d likely have a co-pay, which could be anywhere from a few dollars to up to $50 in some cases. But what if your insurance only covers 10 visits and you need 20? If you run out of visits and you originally ran your physical therapy through your insurance you now could pay up to $350 for that same visit depending on what is done (manual therapy, stem, ice, exercises…you get the picture). The physical therapy office contacted by West Virginia Public Broadcasting said they can’t go back to the cash price for a visit due to an agreement with insurance companies.

“You know part of it is I can’t afford those copays and some of it is transportation I can’t afford to get there,” said Abraham. For others, though, pills are just easier.

“I have a one time copay and I have one pill that I can take from the comfort of my home so it’s trying to shift that mindset toward a more healthy approach to a lifestyle,” said Abraham.

In some cases, she said, like cancer, or chronic disease, opioid prescriptions are appropriate. But what physical therapy does is give a low risk alternative that can be just as effective without the side effects. But in order for physical therapy to truly be accessible to people, she said, there needs to be some policy changes that help people afford it.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.