Patients who underwent physical therapy soon after being diagnosed with pain in the shoulder, neck, low back or knee were approximately 7 to 16 percent less likely to use opioids in the subsequent months, according to a new study by researchers at the Stanford University School of Medicine and the Duke University School of Medicine.

For patients with shoulder, back or knee pain who did use opioids, early physical therapy was associated with a 5 to 10 percent reduction in how much of the drug they used, the study found.

The study, from an analysis of private health insurance claims for care and prescriptions between 2007 and 2015, was published in JAMA Network Open. Eric Sun, MD, PhD, assistant professor of anesthesiology, perioperative and pain medicine at Stanford is the lead author. Steven George, PhD, professor of orthopaedic surgery at Duke, is the senior author.

The findings, Sun said, could be helpful to clinicians in search of pain-management options that carry fewer health risks than opioids. Studies have shown exercise therapy, a component of physical therapy, reduces pain and improves function for some musculoskeletal conditions. Other studies have shown that patients with past prescriptions for opioid pain medication are at increased risk for overdose and misuse.

“This isn’t a world where there are magic bullets,” Sun said. “But many guidelines suggest that physical therapy is an important component of pain management, and there is little downside to trying it.”

The study also measured whether early physical therapy was associated with a decreased need for opioids in the long term among patient who filled prescriptions. The researchers measured the quantity of opioids by converting prescribed amounts to oral morphine milligram equivalents.

They found, after adjusting for confounding factors, that patients who had undergone early physical therapy used 10.3 percent less opioid medication for knee pain; 9.7 percent less for shoulder pain; and 5.1 percent less for back pain in the period three months to a year after their diagnosis. There was no significant reduction for neck pain.

Physical therapy within three months of diagnosis also was associated with a decreased likelihood that patients with two of the conditions would chronically use opioids in the long term, according to the study. After early physical therapy, patients with knee pain were 66 percent less likely in the period three months to a year after their diagnosis to either fill 10 or more prescriptions or acquire a supply of opioid medication for 120 days or more. Patients with low back pain were 34 percent less likely to be chronic users if they had early physical therapy. There was no association between physical therapy and chronic opioid use among patients with shoulder or neck pain.

“The general consensus is that for musculoskeletal pain, opioids generally aren’t a long-term solution,” Sun said. “Aside from all the other side effects, even if the medication is doing well for you, it will have less and less effect over time as your body builds up a tolerance.”