The need to manage chronic musculoskeletal pain has, in part, fueled a global opioid crisis. Osteoarthritis, a disease that includes abnormal changes in cartilage, bone, muscles, and other joint tissues, is a leading cause of chronic pain in adults who are middle-aged and older, with knee osteoarthritis accounting for more than half of those with arthritis worldwide, according to the Institute for Health Metrics and Evaluation. And while exercise and education provided by physical therapists are recommended first-line interventions for knee osteoarthritis, opioids are often prescribed first.

But new BU research shows that the sooner a patient starts physical therapy after being diagnosed with knee osteoarthritis, the less likely they are to become reliant on opioids. The research was published this year in the British Journal of Sports Medicine by Deepak Kumar, an assistant professor of physical therapy, and colleagues at the BU Chobanian & Avedisian School of Medicine and BU Physical Therapy Center.

Kumar and colleagues analyzed insurance claims data from approximately 67,000 people spanning 19 years. They found that delaying the start of physical therapy by more than one month after a diagnosis of knee osteoarthritis was related to greater risk of opioid use, including long-term use. Importantly, findings were the same whether or not the person had a history of opioid use.

“These findings suggest that healthcare providers and patients should strive to initiate physical therapy early to reduce the risk of opioid use,” Kumar says. “The longer the delay, the greater the risk.”