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The Opioid Crisis

You’ve noticed.  I’ve noticed.   Mainstream media is covering the opioid crisis more and more.

The New York Times published a terrific editorial about the opioid crisis.  The article is great in that it talks about what led to this crisis and how it’s another case of history repeating itself. However, the article falls short by failing to promote solutions other than medical management.

What other solutions are there?
Sarah Wenger and colleagues published a paper in the Physical Therapy Journal about reducing opioid use for patients with chronic pain. Wenger and colleagues outline helpful points for physios who care for people using opiods.  Practicioners, like you and I, should watch for opioid use disorder using the “Four ‘C’s”: 

  • adverse consequences,
  • impaired control,
  • compulsive use, and
  • craving.

And what about opiod tapering?
Even though there is no “standard”, “the Mayo Clinic and the CDC suggest a decrease of 10% of the original dose every 5 to 7 days until 30% of the original dose is reached, followed by a 10% decrease of the remaining dose per week for the remainder of the taper.”

Want more resources for those in pain? 
I agree with Paul MintkenJeff Moore, and Tim Flynn, who emphasized the role of education in solving the opioid epidemic. 
In fact, Sarah Wenger developed a program called Power Over Pain, which has an awesome library of resources for those in pain.

Mindfulness… for your patients and for you

Can you improve overall well-being with a mindfullness app?

Bostock et al (2018) published an article showing some fascinating effects of a mindfulness intervention based on a mobile app. After eight weeks of meditation (an average 17 sessions), those who meditated reported a significant improvement in well-being, distress, job strain, and perceptions of workplace social support compared to the waitlist control group.  At 16-week follow-up, positive effects remained for well-being and job strain. 

What I find so interesting is that meditation leads to positive attitudes toward work  — even though the mindfulness intervention did not mention work or the workplace at all. 

In my own life, I like to use apps like Headspace or Calm, so that I get push notifications reminding me to take a quick breather in the morning before clinic… and sometimes in the middle of clinic, too.

Looking for more? The Harvard Gazette published a impressive piece about mindfulness meditation that describes not only the evidence about mindfulness but also some guidance for those interested in trying it. 

Achilles’ Last Stand

The May issue of the Journal of Orthopaedic and Sports Physical Therapy includes an update of clinical practice guidelines for treatment of midportion achilles tendon pain. Though the update includes many interesting sections, I am especially happy to see heavy-load, slow-speed resistance training included as an option for exercise prescription.

One example of heavy-slow resistance training that I use often when treating achilles tendinopathy is described in this randomized trial from Beyer and colleagues. In brief, use standing calf raises with a barbell, seated calf raises weighted, and plantarflexion using a leg press machine. Start with 3 sets of 15RM, three time per week, 3 seconds in each direction for the concentric and eccentric phase, then over time phase down the repetitions per set while increasing the intensity.

Other interesting highlights from the practice guidelines include recommending that therapists do NOT use therapeutic tape or night splints, and that due to contradictory evidence there are no recommendations for heel lifts, orthotics, or low-level laser. There is also moderate evidence that adding iontophoresis with dexamethasone may benefit those with acute midportion achilles tendinopathy.

What’s Next?

If you liked this post, then I would love to hear from you! Leave a comment or tweet me @zachrstearns — just use the hashtag #physioweekly.

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