With the recent withdrawal of Bextra®, manufactured by Pfizer, New York, patients have one less drug option for pain relief. Bextra, a Cox-2 selective nonsteroidal anti-inflammatory drug (NSAID), which was indicated for the treatment of osteoarthritis and rheumatoid arthritis, was among Pfizer’s top-selling products and accounted for $1.3 billion in sales in 2004.1 

Bextra’s exit from the US consumer market followed relatively closely behind the extraction of another widely used medicine, Vioxx®, manufactured by Merck & Co Inc, Whitehouse Station, NJ, which was indicated for osteoarthritis and acute pain management in adults. Vioxx garnered worldwide sales of $2.5 billion in 2003,2 before Merck voluntarily withdrew the drug in September 2004.

Despite the reported increase in cardiovascular and gastrointestinal risks that eventually caused the market withdrawal of these medications, the financial success of Bextra and Vioxx indicates that patients are heavily dependent upon drugs to manage pain. But a larger issue is not being addressed: Although these medications do relieve pain, they do not address the underlying causes of medical conditions. Physical therapists can play an important role in educating patients about a more well-rounded approach to managing pain.

What many patients do not realize is that physical therapy can help target the root causes of pain and may decrease their sole dependency on pain medication. The American Physical Therapy Association released a statement pointing out that many factors can exacerbate soreness and aching, and hence intensify pain caused by certain conditions.

“There is certainly a role for medications to play in painful conditions; however, physical therapists are here to evaluate the source of pain and look at possible interventions at the underlying source,” says Barbara Sanders, PhD, PT, SCS, professor and chair in the Department of Physical Therapy, associate dean in the College of Health Professions at Texas State University-San Marcos in San Marcos, Tex, and editorial advisory board member of Physical Therapy Products (PTP). “For example, musculoskeletal pain may be due to poor biomechanics, or due to weak or inflexible muscles that provide core support. In the case of joint pain, relief of stress by improving muscle strength, adding a brace or splint, and changing the support system can make a big difference,” she says. “The role of the physical therapist is to look at underlying causes and then determine if PTs can provide an intervention to deal with pain, performance, return to activity, or if referral is appropriate.”

With new technologies for pain and wound management, the implementation of different therapy practices, such as tai chi and pilates, and continuing in-depth medical research, there is no other field better poised to provide patients with treatments that not only ease pain, but help resolve it at its core.

As the new editor of PTP, I look forward to witnessing the growth and contributions of this dynamic discipline.

References

1. Smith A. Pfizer pulls Bextra off the market. Available at:  http://money.cnn.com/2005/04/07/news/fortune500/bextra Accessed April 15, 2005.

2. Vioxx information page. Merck & Co Inc Web site. Available at: www.vioxx.com/rofecoxib/vioxx/consumer/index.jsp Accessed April 15, 2005.