How Physical Therapy Can Reduce the Use of Opioids in Patients with Musculoskeletal Conditions

The opioid crisis has taken a devastating toll on the United States, with an estimated 54,743 opioid overdose deaths in the U.S. in 2024 alone.¹ Beginning in the 1990s, new, more potent versions of opioids began to hit the market. Due to an overreliance on opioids to treat pain, the crisis has evolved into a complex epidemic with far-reaching consequences affecting both individual lives and entire communities. And while opioid painkillers remain an effective tool in a physician’s tool belt, drugs like OxyContin and fentanyl became a widely prescribed first resort for pain, despite evidence of their addictive potential.²

While much attention has been given to overdose prevention and addiction treatment, a growing body of research highlights an essential but underutilized strategy in opioid misuse prevention: early use of conservative physical therapy. For patients with musculoskeletal (MSK) conditions—such as low back pain, joint dysfunction, or pre- and post-op surgery—physical therapy (PT) offers a highly effective, non-pharmacologic alternative to opioids, targeting pain at its source and reducing reliance on medications that carry high risk for addiction and overdose.

The Link Between MSK Conditions and Opioid Use

Musculoskeletal conditions are among the leading diagnoses associated with opioid prescriptions in the U.S.^3,4 Back and joint pain, post-surgical recovery, and chronic musculoskeletal dysfunction can lead to prescriptions for pain management—often as a first-line intervention. Unfortunately, these prescriptions can lead to long-term opioid use and, in some cases, addiction.

Research shows that patients with chronic MSK pain are at elevated risk for prolonged opioid use, especially when pharmacologic interventions are used in place of active, movement-based care.⁵ Many of these patients could benefit from earlier access to physical therapy, as over 75 percent of individuals with opioid misuse behaviors report musculoskeletal pain.^6,7

How Physical Therapy Can Reduce Opioid Use

Physical therapy addresses pain through movement, manual techniques, patient education, and exercise. This approach not only improves physical function but also reduces the need for opioids.

1. Treating the Root Cause of Pain

Physical therapists conduct thorough assessments to identify biomechanical, postural, or movement dysfunctions contributing to pain. Rather than masking symptoms, PT helps resolve the root causes of discomfort or pain, promoting long-term recovery without reliance on drugs.

New technology, such as motion capture analysis, is helping to support providers in their analysis of patients’ functional movement, range of motion, and identify limitations.

2. Early PT Can Lead to Lower Opioid Use

Research shows that patients who receive physical therapy early—particularly within the first 14 days of symptoms—are significantly less likely to be prescribed opioids.⁸ One study concluded that when physical therapy was used within three months of a musculoskeletal pain diagnosis, such as lower back, shoulder, or knee pain, patients were less likely to use opioids in the months following the injury.⁹

Unfortunately, many patients experience access-to-care issues including long wait times or significant distances to the nearest providers. But with hybrid care platforms like Medbridge Pathways, clinicians can significantly reduce wait times and get patients started with early education and exercise programs before (or in lieu of) an in-person appointment.

3. Treating Chronic Pain and Reducing the Need for Surgery

Early PT intervention can help prevent acute pain from developing into chronic pain, which is a major predictor of long-term opioid use, and can also mitigate some existing chronic pain symptoms. Additionally, PT has been shown to reduce some of the need for invasive procedures such as surgery, which often involve post-operative opioid prescriptions. One study found that using physical therapy was associated with reduced likelihood of patients receiving surgery within one year.¹⁰

4. Improving Patient Self-Management

Physical therapists empower patients with strategies to manage their symptoms independently. Through education and guided exercise programs, patients learn to regulate flare-ups, improve mobility, and build strength, resulting in decreased reliance on passive treatments, including opioids.

Growing evidence also supports teaching patients the underlying neuroscience of their pain experience, referred to as pain neuroscience education. The Introduction to Pain Neuroscience Education by Dr. Adriaan Louw, PT, PhD, serves as an introduction into how to implement pain neuroscience education in clinical practice.

How Medbridge Can Help

Physical therapy is a powerful, evidence-based strategy to reduce the initial reliance on opioids, address pain at its root, and support long-term recovery. Integrating PT earlier in care pathways can substantially reduce opioid exposure,  improves long-term health outcomes for patients with MSK conditions, and aligns with the CDC’s recommendations to use non-pharmacologic pain management as a first-line approach for chronic pain.¹¹

Medbridge Pathways is our digital hybrid care platform that supplements in-person therapy programs with a variety of care pathways that provide more efficient, effective, and personalized care for a variety of musculoskeletal and specialty conditions.

Prescribed by a clinician, each Pathway is tailored to the unique needs of each patient and broken into multiple phases that build off each other, allowing patients to progress at their own pace as their pain decreases and they build strength. Individual phases are focused on a set of exercises designed to be completed in 15 minutes or less.

Pathways offers flexible, effective, and evidence-based programs that help expand access to physical therapy care for patients who may not have access to care.

Conclusion

Opioids are a common treatment strategy for patients with MSK pain, but physical therapy offers a safer, evidence-based alternative that can significantly reduce opioid use. By addressing pain at its source and promoting functional recovery, PT helps patients avoid the risk of addiction while improving quality of life. Widespread adoption of early physical therapy interventions—particularly for MSK conditions—represents a powerful alternative to opioid treatment.

References:

1. _{https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2025/20250514.htm}

2. _{Van Zee, A. (2009). "The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy." American Journal of Public Health, 99(2), 221–227. https://doi.org/10.2105/AJPH.2007.131714}

3. _{https://med.stanford.edu/news/all-news/2018/12/early-physical-therapy-can-reduce-risk-of-long-term-opiod-use.html}

4. _{De Sola, H., Dueñas, M., Salazar, A., Ortega-Jiménez, P., and Failde, I. (2020). Prevalence of therapeutic use of opioids in chronic non-cancer pain patients and associated factors: a systematic review and meta-analysis. Frontiers in Pharmacology, 11, 564412}

5. _{Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315(15):1624–1645. doi:10.1001/jama.2016.1464}

6. _{Sherry, T. B., Sabety, A,, and Maestas, N. (2018). Documented pain diagnoses in adults prescribed opioids: results from the National Ambulatory Medical Care Survey, 2006–2015. Annals of Internal Medicine, 169(12), 892–894.€}

7. _{Morasco, B. J., Yarborough, B. J., Smith, N. X., Dobscha, S. K., Deyo, R. A., Perrin, N. A., and Green, C. A. (2017). Higher prescription opioid dose is associated with worse patient reported pain outcomes and more health care utilization. Journal of Pain, 18(4), 437–445.€}

8. _{Sun, E. et al. (2018). "Early Physical Therapy vs Usual Care in Patients With Low Back Pain: A Randomized Clinical Trial." JAMA, 319(3): 237–246.}

9. _{Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain.}

10. _{Fritz JM, Lurie JD, Zhao W, Whitman JM, Delitto A, Brennan GP, Weinstein JN. Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study. Spine J. 2014 Aug 1;14(8):1611-21. doi: 10.1016/j.spinee.2013.09.044. Epub 2013 Oct 23. PMID: 24373681; PMCID: PMC3997631.}

11. _{Centers for Disease Control and Prevention. (2022). "Clinical Practice Guideline for Prescribing Opioids." https://www.cdc.gov/opioids/clinical-practice/index.html}