Can Physical Therapist Prescribe Pain Medication? Here’s What You Need to Know

As we all know, pain is a part of life. It affects us in every way and can hinder our daily activities. Pain medication has been used to help alleviate this discomfort for decades. Physical therapy helps individuals recover from injuries, surgeries, or other issues that may cause chronic pain.

In some cases, physical therapists may prescribe medical treatment along with their methods to achieve better alleviation of pain. This begs the question – Can Physical Therapists prescribe pain medication? This article will provide an extensive guide on what you need to know about the topic.

“Pain is inevitable – suffering is optional.” – Unknown

It is important to understand who can prescribe medications legally and safely, especially when managing pain. Our focus here is whether physical therapists hold the authority to give prescriptions like medical doctors do.

This article aims to give readers insight into what it means for Physical Therapists to prescribe medication, and why they might choose to do so, along with examining any restrictions placed on them by law. We have collaborated to weigh the pros and cons of using a non-md healthcare worker such as a Physical Therapist (PT) manage your pain and prescription medication.

Before diving too deep, let’s first gain a basic understanding of pain management techniques, types of drugs, administration routes, safety measures in taking these psychoactive drugs, misuse/abuse potential, general prescribing rights, and clinical guidelines associated with manual therapy.

Understanding the Role of a Physical Therapist

A physical therapist is a healthcare professional who specializes in assessing, diagnosing, and treating individuals with medical conditions or injuries that limit their movement and mobility. The role of a physical therapist involves helping patients to regain movement, reduce pain, and restore their overall function.

Physical therapists work closely with physicians and other healthcare professionals to develop an individualized treatment plan to help patients achieve their goals. This can include exercises to improve strength, range of motion, and flexibility, as well as manual therapy techniques such as massage, joint mobilization, and stretching.

Physical therapists often work with patients who are recovering from surgery, illness, or injury, but they also provide preventive care for individuals who want to maintain their physical activity level and prevent future injuries.

The Education and Training of Physical Therapists

Becoming a licensed physical therapist requires extensive education and training. Most physical therapists hold doctoral degrees in physical therapy (DPT) from accredited programs. These programs typically take three years to complete and involve both classroom coursework and clinical rotations in various settings.

In addition to completing an accredited PT program, physical therapists must pass a national licensure exam before they can practice. They must also meet ongoing continuing education requirements to maintain their license and stay up-to-date on advancements in the field.

Many physical therapists specialize in certain areas such as orthopedics, pediatrics, sports medicine, geriatrics, neurology, or women’s health, among others. These specialization areas require additional education and training beyond the DPT degree.

The Scope of Practice for Physical Therapists

The scope of practice for physical therapists varies depending on the state where they practice. However, in general, physical therapists are not authorized to prescribe medication, including pain medication.

Instead, physical therapists rely on non-pharmacological interventions such as exercise, manual therapy, and other modalities to manage pain and promote healing. These interventions have been shown to be effective in reducing pain and improving function for many patients.

“Physical therapists can play a critical role in managing chronic pain without the use of medication. Through individualized treatment plans that evaluate each patient’s unique needs, physical therapists help patients develop healthy habits and movement patterns that reduce their pain and improve their overall quality of life.” -American Physical Therapy Association

In cases where medications are necessary, physical therapists may work with physicians to coordinate care and ensure that patients receive the best possible outcomes. Physical therapists must follow state laws and regulations regarding referral and consultation with other healthcare providers, including when it comes to prescribing durable medical equipment or recommending surgical intervention.

Physical therapists are skilled healthcare professionals who play an integral role in helping patients recover from injury or illness, prevent future injuries, and maintain optimal health throughout their lifespan. While they cannot prescribe medication, physical therapists offer a variety of evidence-based interventions to help patients manage pain and achieve their goals.

Types of Pain Medications Prescribed by Physical Therapists

Non-Opioid Pain Medications

Physical therapists can prescribe different types of non-opioid pain medications to their patients. Non-opioid pain medication refers to medicines that do not contain opioids, which are a type of narcotic painkiller drug that can be habit-forming and has a high risk of addiction when used long term.

The most commonly prescribed non-opioid pain medications for physical therapy include:

• Acetaminophen (Tylenol): This is a common over-the-counter medication that helps relieve mild-to-moderate pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These include aspirin, ibuprofen (Advil), and naproxen (Aleve). They help reduce inflammation and relieve pain caused by arthritis, soft tissue injuries, and other conditions.
• Topical NSAIDs: Unlike oral NSAIDs, topical NSAIDs are applied directly on the skin where it hurts to relieve muscle and joint pain and swelling. They are available in cream, gel, or patch form.

It’s important to note that while these medications are effective at relieving pain, they can also have side effects if taken incorrectly. Your physical therapist will work with you to determine what kind of pain medication would be best suited for your individual needs based on your medical history, current symptoms, and overall health.

Opioid Pain Medications

While physical therapists are not authorized to prescribe opioids themselves, they may refer patients to a physician who can prescribe them if necessary.

Opioids are powerful painkillers that can be effective for severe and acute pain, such as after surgery or a trauma. Common opioid medications include oxycodone (Oxycontin), hydrocodone (Vicodin), and morphine.

Opioids carry a high risk of addiction if used long term and should only be used under the close supervision of a medical professional. In cases where opioids may be necessary, physical therapists will work in collaboration with your physician to ensure safe use and appropriate dosages.

Topical Pain Medications

In addition to NSAIDs, there are also topical pain relievers available that can help relieve chronic pain symptoms. Topical analgesics include creams, gels, lotions, sprays, and patches that contain ingredients like menthol, lidocaine, and capsaicin that numb and/or cool the skin’s surface.

Physical therapists may recommend using a topical pain medication along with other treatment techniques to improve your mobility and decrease discomfort. It’s important to follow the instructions on the label carefully and let your therapist know about any side effects you experience.

Injection Pain Medications

If more conventional methods do not provide relief from pain, injections may be considered. Injection therapy involves injecting an anesthetic agent into areas of soft tissue or joints that cause pain, providing temporary but immediate pain relief. This method is particularly useful in managing conditions causing nerve damage or muscle knots.

The most common injection medications for physical therapy include:

• Cortisone: A steroid that helps reduce inflammation in the affected area.
• Lidocaine: A local anesthetic that numbs sensitive tissues and nerves.
• Botulinum toxin type A (Botox): An injectable medication used to treat muscle spasms and other muscle movement disorders.

Your physical therapist may work with your doctor or a pain management specialist to determine if injection therapy is appropriate for you and help manage any side effects that may occur.

“Physical therapists play an important role in the management of chronic pain. They are trained to assess, diagnose, and treat many musculoskeletal conditions using both manual and non-invasive methods, including prescribing appropriate medications.”

While physical therapists cannot prescribe all types of pain medications, they have access to a range of options to help patients manage their symptoms. Physical therapists will carefully consider each patient’s individual needs to determine which pain relief approach best suits them. If conservative treatment methods do not relieve pain, referral to a physician who can provide prescription medication may be necessary.

Criteria for Prescribing Pain Medications by Physical Therapists

Physical therapists are primary healthcare providers who help patients improve their quality of life through the use of exercise, manual therapy, and other modalities. However, some people wonder Can Physical Therapist Prescribe Pain Medication? The answer is that in certain states, physical therapists can prescribe pain medications but only under specific circumstances. These criteria include:

Assessment of the Patient’s Pain Level

The first criterion for prescribing pain medication is to assess the patient’s pain level accurately. A physical therapist should ask the patient about the location, intensity, duration, and type of pain they feel. This information helps determine the nature and source of the patient’s pain. Based on this assessment, a physical therapist may recommend over-the-counter (OTC) pain relievers or refer the patient to a medical doctor.

Consideration of the Patient’s Medical History

A second factor when considering if a Physical Therapist can prescribe pain medication is reviewing the patient’s medical history. It is crucial to consider the patient’s age, gender, past illnesses, current health status, allergies, and any chronic diseases. In addition, the physical therapist should know if the patient is taking any prescribed medication and what effects these drugs have on their body. They need to understand the patient’s comorbid conditions will affect their response to the medication. All these factors come into account to decide if it’s safe to prescribe medication to the patient.

Review of the Patient’s Current Medications

The third condition before prescribing drug therapy to the patient is to review their current medications. At times interaction between two different medicines could cause adverse effects. For instance, taking warfarin with aspirin can increase the risk of bleeding, which might be lethal. Therefore, reviewing the patient’s current medication is essential to prevent any adverse interaction and create suitable drug therapy for the patient.

Physical therapists cannot prescribe all categories of pain drugs. In most states, physical therapists have limited prescriptive authority to opioids or other prescriptions only if they fall into the classification of Schedule III – V controlled substances as per federal law under the Comprehensive Drug Abuse Prevention and Control Act of 1970 (also known as the Controlled Substances Act).

“It’s important that patients are aware that laws relating to prescriptive authority vary by state.” – Sarah Haag PT, DPT

The Physical Therapist needs to obtain a DEA number which gives authorization to write prescriptions allowed by their specific jurisdiction’s laws according to the Drug Enforcement Administration (DEA).

• Before prescribing pain medications, physical therapists must:
• Determine if they belong to jurisdictions allowing physical therapist prescriptive authority
• Meet necessary educational qualifications set in place
• Acquire approval from State Board Authorities before beginning to use this authority legally.
• In conclusion: Can Physical Therapists Prescribe Pain Medications? The answer relies heavily on specific conditions that need consideration when initial assessment and screening occurs.

While it’s great news that some States allow prescribing power for qualified clinicians, not every case will call for prescription medication. Every person coming for therapy may require unique treatment specific to them. It is crucial to trust your physical therapist with their knowledge and skillset to provide appropriate relief in due course of extensive research and assessments. Partnering between healthcare providers such as medical practitioners and PTs can be instrumental in offering comprehensive care plans for those who have chronic illnesses involved and manage pain control plans minimizing prescription drug reliance while aiming to improve their overall health/wellness.

Collaborating with Other Healthcare Professionals for Pain Management

Pain management is often a collaborative effort among healthcare professionals. It involves treating the pain itself as well as addressing underlying conditions that may be causing it. Working together, healthcare providers can create a comprehensive treatment plan that addresses physical, emotional, and mental well-being of patients.

Working with Primary Care Physicians

Primary care physicians are often the first point of contact for patients experiencing pain. These doctors have training in managing medical conditions as well as providing preventive health care. They evaluate, diagnose, and treat various illness and injuries including chronic pain. Working together, primary care physicians and physical therapists can provide more coordinated care to their patients, helping to minimize confusion about diagnosis and medications so that everyone is on the same page, upholding patient safety.

Primary care physicians and physical therapist collaborate in many ways through shared decision making, sending electronic messages or calling to discuss patient history or status, meeting in nurse practitioner care coordination centers, and more. The goal is to integrate communication systems and use other platforms such as telehealth-tools, text messaging services, secure emails/accounts to reduce barriers to sharing information that leads towards evidence-based practices that support prescriptive authority by qualified healthcare practitioners.

Referring to Pain Management Specialists

While primary care physicians are trained to manage a broad range of medical needs, some patients require additional specialized care from pain management specialists. Pain management clinics can offer advanced treatments such as nerve blocks, steroid injections, and even surgical procedures. Physical therapists work closely with these specialists, referring patients to them when necessary and collaborating to ensure that each patient receives the best possible care for their specific condition and situation. Physical therapists who aspire to greater roles may want to pursue post-professional education opportunities in pain science for competencies required in emerging practice.

Coordinating with Physical Therapists

Sometimes patients can benefit from physical therapy, which can help alleviate pain by improving muscle strength and flexibility. By working with a physical therapist, patients can regain mobility and strength while also learning how to manage their condition long-term through proactive exercises at home. Physical therapists collaborate with physicians to design individualized treatment plans that meet the unique needs of each patient.

Mary Lou Galantino, PT, PhD, MSCE, Professor of Rehabilitation Sciences and Director of Behavioral Health Outcomes & Translational Research Lab in US stated: In more recent years, there has been an acknowledgement among physical therapy communities of pain as not only a physical but a biopsychosocial experience; we have recognized dysfunctional pain physiology as a contributor to aberrant motor learning, excessive guard reaction, pain avoidance behaviors, poor mood and well-being all form part of chronic pain as a biopsychosocial disorder and increasingly been aware of our role as primary care practitioners for managing these conditions (APTA).”

Collaborating efficiently is important across various healthcare professionals involved in addressing pain management issues. The involvement of a team allows for diverse knowledge sharing and prompt alleviation of pain, enlightening healthcare systems on best practices to uphold quality care standards. Furthermore, physical therapist play a significant role in this aspect providing holistic approaches such as education, manual techniques, rehabilitation tools, and active self-management programs. Importantly, physical therapists cannot prescribe medication including opioids like buprenorphine, codeine, oxycodone, hydrocodone or Fentanyl patches without attaining a specialized certification required at your professional licensing organizations, so referral to a greater healthcare provider may be necessary. Nevertheless, it’s worth highlighting that significant collaborative effort amongst healthcare partners immensely helps mitigate negative events linked to pain medication prescription/drug abuse of impact patients safety and welfare.

Alternative Pain Management Techniques Offered by Physical Therapists

Mind-Body Techniques

Physical therapists can offer various alternative pain management techniques, including mind-body techniques, for their patients suffering from chronic pain. Mind-body techniques primarily focus on the interdependence of mental and physical health to minimize chronic pain. One such technique is meditation, which has been shown to have a positive impact on stress reduction and pain management. Several studies suggest that mindfulness meditation effectively manages chronic pains caused due to arthritis, lower backaches, fibromyalgia, and diabetic neuropathy.

A study conducted at the University of Utah School of Medicine found that people who practiced mindfulness meditation reduced their experience of physical pain by 40 percent when compared to the control group. Deep breathing exercises are another effective way to calm your nervous system and alleviate pain. By focusing on slow, deep inhalations and exhalations, it helps improve oxygen levels in the body. This increased awareness or conscious breathing helps decrease muscle tension and anxiety that often cause or exacerbate pain sensations.

Manual Therapy

In manual therapy techniques, a physical therapist uses his/her hands to aid in improving circulation, reduce swelling, and relieve pain experiencing pressure and stretching exercises.

A great example of this technique is spinal mobilization. Spinal mobilization is similar to chiropractic adjustments, where the spine joints’ restrictions are removed by performing manual manipulations. These manipulations can improve flexibility and mobility in localized areas. It may also help with vertebral alignment. However, before prescribing any kind of manual treatment, it’s crucial that a physical therapist takes a thorough patient history.

Most importantly, prescription medication for relieving pain should not be given lightly as reported drug addiction rates continue to rise staggering numbers. Physical therapists must exhaust every non-pharmaceutical alternative pain relief option before considering prescribing the medication.

“Physical therapists have a duty to caution their patients about dangerous effects of opioid medications and recognize how easily addiction can occur. In doing so, PTs should inform their patients that physical therapy is not only an excellent alternative but also safer and generally more effective.”

– Susan R. Johnson, M.D., Acting Director of CDER’s Division of Nonprescription Drug Products

Frequently Asked Questions