Background: Chronic low-back pain is a leading cause of disability and a major driver of opioid prescribing. Opioids provide limited long-term benefit and carry risks including dependence and adverse effects. PT is a first-line, non-pharmacologic intervention that may improve function and reduce opioid use, yet comparative evidence remains limited. Objective: This review compares functional outcomes and opioid utilization between PT and opioid therapy in adults with chronic low-back pain.
Methods: A literature review was conducted using PubMed, MEDLINE, and Cochrane Library for studies published in English from 2000-2025. Eligible studies included RCTs, cohort studies, and systematic reviews reporting pain, function, or opioid outcomes. Two reviewers screened abstracts and full texts. Study quality and risk of bias were assessed using the Cochrane Risk of Bias tool, Newcastle-Ottawa Scale, and AMSTAR. Findings were synthesized qualitatively. Of 56 studies screened, 22 met inclusion criteria.
Results: Opioids provided modest short-term pain reduction (<1 point/10) and minimal functional improvement, limited to 3-6 months. PT improved function (1-3 points), mobility, and pain-related disability; 10 of 12 RCTs showed significant gains. Cohort studies and systematic reviews reported reduced opioid use in PT patients. No studies favored opioids. Limitations included heterogeneity in protocols, outcome measures, and short follow-up.
Conclusion: PT yields superior functional outcomes and lower risk compared with opioid therapy for chronic low-back pain. By synthesizing high-quality evidence, this review reinforces rehabilitation-first strategies and addresses gaps in prior pain-focused reviews.
Methods: A literature review was conducted using PubMed, MEDLINE, and Cochrane Library for studies published in English from 2000-2025. Eligible studies included RCTs, cohort studies, and systematic reviews reporting pain, function, or opioid outcomes. Two reviewers screened abstracts and full texts. Study quality and risk of bias were assessed using the Cochrane Risk of Bias tool, Newcastle-Ottawa Scale, and AMSTAR. Findings were synthesized qualitatively. Of 56 studies screened, 22 met inclusion criteria.
Results: Opioids provided modest short-term pain reduction (<1 point/10) and minimal functional improvement, limited to 3-6 months. PT improved function (1-3 points), mobility, and pain-related disability; 10 of 12 RCTs showed significant gains. Cohort studies and systematic reviews reported reduced opioid use in PT patients. No studies favored opioids. Limitations included heterogeneity in protocols, outcome measures, and short follow-up.
Conclusion: PT yields superior functional outcomes and lower risk compared with opioid therapy for chronic low-back pain. By synthesizing high-quality evidence, this review reinforces rehabilitation-first strategies and addresses gaps in prior pain-focused reviews.