Two University of Iowa researchers are proposing a new avenue for treating pain that may have a significant impact on the U.S. opioid epidemic.

Kathleen Sluka, professor of Physical Therapy, and Barbara Rakel, professor of Nursing, are piloting a program encouraging the “prescribing” of targeted exercises and transcutaneous electrical nerve stimulation (TENS) to patients suffering from chronic musculoskeletal pain. The goal is to encourage primary care physicians to first reach for these non-drug therapies rather than prescription pills. The novel non-pharmaceutical study is supported with a $708,542 grant from Pfizer and the American Pain Society.

“We are going beyond prescribing physical therapy, and providing a prescription for exercise and TENS that would not always require a referral to physical therapy,” said Sluka. “This, in our eyes, will place TENS and exercise at the same level of importance as medications to the physician and to the patient.”

It is often the case that both patients and health care providers think pharmaceuticals when it comes to “prescribing” a treatment, Sluka said. This project is innovative because it moves the prescription of non-pharmacological pain strategies to the same level as pharmacological strategies using the existing electronic health record template. To help providers effectively customize and prescribe these non-pharmacologic pain treatments, Sluka and Rakel are developing new algorithms for the Epic medical records software system, used at the UI Hospitals and Clinics.

“We already have a system in place within Epic to refer people to physical therapy,” said Sluka. “However, not all people with chronic pain are referred to physical therapy, nor do all people with chronic pain need to be referred for physical therapy. Some primary care providers counsel patients to perform exercise without referral, and we believe that some individuals can perform exercise independently at home, community centers, or local gyms.”

While this approach is not primarily designed to prevent opioid use or addiction, Sluka and Rakel strongly suspect reducing opioid use will be a secondary outcome.

If the new procedures prove successful at the UI Hospitals and Clinics, the hope is this approach could be standardized across all U.S. hospitals that use the Epic medical records software system, roughly 50 percent of hospitals in the country.

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