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Treating patient pain is never a simple affair. There are many types of pain and until recently doctors had few options to help ease patient pain. Opioid-based pain medicines have been the primary option for pain relief for thousands of years, but the risks of using them for more than a short period are well documented – addiction is a serious and potentially long-lasting side effect.
Ironically, the same opioid medications that promise pain relief from traumatic injury change a person’s body in ways that create pain when an addicted person stops using them. Symptoms of withdrawal include sweating, tremors, sweating, restless legs syndrome, stomach upset, muscle and joint pain and anxiety. Unfortunately, detoxification from opiates takes 30 days or more. In the withdrawal process, symptoms are most frequent and intense during the first week or two of detoxification – a period known as acute withdrawal. The pain of opioid withdrawal is the primary reason most addicts never achieve sobriety.
While recovering from opioid addiction is not a simple process, clinicians should not ignore the pain patients report and experience. Even if an addict achieves a detoxified state, there are frequently underlying comorbidities (illness or environmental factors) that need to be addressed before long-term success can be achieved. It follows that relapse is likely and this is where withdrawal pain becomes more problematic. Addicts that have been through acute withdrawal more than once will frequently have increased anxiety when confronting voluntary detoxification – they’ve tried it before and remember the pain they experienced.
In November 2017, the FDA granted a new indication to an electric stimulation device for use in helping to reduce the symptoms of opioid withdrawal. Devices like this one attach to a patient’s ear and send small electrical signals into the nervous system via specific branches of cranial nerves. In a clinical study presented to the FDA, patients reported a decrease of at least 30 percent in severity of symptoms.
Withdrawal pain primarily arises from a neuro-chemical imbalance created by prolonged exposure to opioids1. In addicts, noradrenaline levels, regulated by the locus ceruleus at the base of the brain, are higher – the body increases the neurochemical to normalize the effects of the opioid. In withdrawal, opioid levels rapidly drop, while noradrenaline levels take weeks to stabilize to normal levels. Until noradrenaline levels stabilize, the patient experiences severe and acute pain resulting from the overstimulated systems.
In a withdrawal scenario, neurostimulation devices can be used to interfere with the pain signals coming from the body and reduce the severity of the withdrawal experience. The advantages to recovery are quite simple – the device helps to reduce the pain associated with withdrawal and therefore contributes to lower potential for relapse. Patients treated with neurostimulation during acute withdrawal syndrome report less server nausea, phantom muscle pain and restless leg syndrome type symptoms.
Rapid reduction of opioid antagonists in the body during the detoxification process contributes to quicker recovery from physical dependency, but has the downside of increased symptom severity. When combined with the use of naltrexone, a drug that mimics and blocks and quiets opioid receptors, neurostimulators are being used to augment and complement existing methodologies for treating dependency. Clinicians are provided greater control over the patient’s withdrawal syndrome symptoms, helping them to decrease patient discomfort.
The procedure is quick and minimally invasive. A small device that emits low intensity electrical impulses is connected to a small needle array that is inserted percutaneously into the patient’s skin at specific points, such as the triangular fossa of the ear which contains a branch of the vagus nerve. The device is then affixed to the patient where it remains throughout the treatment protocol, which lasts several weeks.
The low-level electrical current is highly tolerated; however, devices with adjustable current settings are valuable in withdrawal scenarios where patients may often present with heightened sensitivity or mental duress.
As with other treatment methodologies, neurostimulation is attractive option to clinicians due to its non-pharmacological and minimally invasive nature. Neurostimulation has long been a tool for pain management specialists, but its application in addiction medicine is encouraging at a time when opioid addiction is reaching epidemic levels.
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Complementary therapy to increase the transcutaneous oxygen partial pressure. Treatment to reduce the intensity of acute pain.
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