CHRONIC PAIN AND ADDICTION Presented By: Rick Sponaugle, M.D. Board Certified Addictionologist Board Certified Anesthesiologist & Medical Director of Florida Detox ® & Wellness Institute

WHAT IS PAIN? Pain: Excess electricity in the nerve Example: Lumbar disc pinches sciatic nerve Increased electricity to brain via spinal cord Electricity (pain) measured in brain (volt meter) If brain chemistry optimized - less pain

Pain: Excess electricity in the nerve

Example:

Lumbar disc pinches sciatic nerve

Increased electricity to brain via spinal cord

Electricity (pain) measured in brain (volt meter)

If brain chemistry optimized - less pain

PAIN SENSITIVE BRAIN CHEMISTRY DOPAMINE DEFICIENCY SEROTONIN DEFICIENCY GABA DEFICIENCY GLUTAMATE EXCESS HISTAMINE EXCESS

DOPAMINE DEFICIENCY

SEROTONIN DEFICIENCY

GABA DEFICIENCY

GLUTAMATE EXCESS

HISTAMINE EXCESS

Pain medication like Vicodin ® and Oxycontin ® are utilized to reduce the increased electrical current from pain signals Problem: These medications do not discriminate; they reduce electrical current throughout the brain and body OPIOID PAIN MEDICINE

Pain medication like Vicodin ® and Oxycontin ® are utilized to reduce the increased electrical current from pain signals

Problem: These medications do not discriminate; they reduce electrical current throughout the brain and body

Normal Brain (SPECT Brain scan from Brainplace.com, Dr. Daniel Amen) 7 years Methadone use, some prior Heroin

Opiates Reduce Neuronal Interconnections In time-lapse images, treatment with morphine decreased the number of spines (arrows). Courtesy Dezhi Liao , University of Minnesota Liao concluded that while some level of endogenous opioid is needed to keep excitatory neurons healthy, the drug morphine "changes the structure of excitatory synapses. If someone constantly takes morphine, eventually it will damage the brain, change its structure and function,” whyfiles.org/225drug_receptors/images/opiate_receptors.jpg

Daily Consumption of Pain Medication Decreased activity of “happy” brain chemicals Dopamine & Serotonin Low serotonin activity – overactive limbic system brain becomes more sensitive to pain Low dopamine activity – underactive pleasure center Patient develops depression Brain becomes more sensitive to pain Florida Detox - immediate correction of dopamine and serotonin deficiencies reduces pain sensitivity

Decreased activity of “happy” brain chemicals Dopamine & Serotonin

Low serotonin activity – overactive limbic system

brain becomes more sensitive to pain

Low dopamine activity – underactive pleasure center

Patient develops depression

Brain becomes more sensitive to pain

Florida Detox - immediate correction of dopamine and serotonin deficiencies reduces pain sensitivity

27 year old female: Oxycontin 300 mg/day

PLEASURE CENTER nida.nih.gov/pubs/teaching/Teaching2/Teaching5

Low Dopamine D2 Receptor Activity in the Brain’s Pleasure Center Causes Depression Nerve A Nerve B Happy Receptor D 2

2005 NIDA Study Food Addiction Low D 2 receptor activity noted on PET scan 300 pound females have 50% less D 2 activity than normal weight females

Food Addiction

Low D 2 receptor activity noted on PET scan

300 pound females have 50% less D 2 activity than normal weight females

OPIOID PAIN MEDICINE 27 year old male from Boston presents to Florida Detox & Wellness Institute, January 2009 Drug: Oxycontin, 800 mg/day Diagnoses: ADHD Over-active limbic Over-active cingulate Over-active basal ganglia Low serotonin Rule out neurotoxicity

27 year old male from Boston presents to Florida Detox & Wellness Institute, January 2009

Drug: Oxycontin, 800 mg/day

Diagnoses:

ADHD

Over-active limbic

Over-active cingulate

Over-active basal ganglia

Low serotonin

Rule out neurotoxicity

… Two months after detox, Dr. Sponaugle referred patient to Amen Clinic because medical history positive for severe brain trauma

The left brain process information in logical analytical stages

The left brain process information in logical analytical stages

Right side – The Artistic Brain

Right side – The Artistic Brain

Pituitary gland suppression: P ituitary gland - stimulates the thyroid , adrenal glands , testicles and ovaries . Hypothyroidism Growth Hormone deficiency Testosterone deficiency Estrogen deficiency Progesterone deficiency Adrenal gland suppression DHEA deficiency Adrenaline deficiency Cortisol deficiency Daily Consumption of Pain Medication

Pituitary gland suppression:

P ituitary gland - stimulates the thyroid , adrenal glands , testicles and ovaries .

Hypothyroidism

Growth Hormone deficiency

Testosterone deficiency

Estrogen deficiency

Progesterone deficiency

Adrenal gland suppression

DHEA deficiency

Adrenaline deficiency

Cortisol deficiency

Hormonal Assessment Thyroid Function TSH Free T3 & Free T4 Testosterone Estradiol Progesterone DHEA-s LH FSH ACTH & Cortisol Growth Hormone

Thyroid Function

TSH Free T3 & Free T4

Testosterone

Estradiol

Progesterone

DHEA-s

LH FSH

ACTH & Cortisol

Growth Hormone

Hypothyroidism Depression Fatigue Cold intolerance Memory problems Dry skin Weight gain High cholesterol High blood sugar Constipation

Depression

Fatigue

Cold intolerance

Memory problems

Dry skin

Weight gain

High cholesterol

High blood sugar

Constipation

Hypothyroidism Opiate Pain Medicine, benzodiazepines, and alcohol Pituitary suppression of thyroid stimulation hormone (TSH) Must measure T3 “ active thyroid ” TSH may be suppressed even though T3 T4 are low Females are more susceptible to hypothyroidism Florida Detox ® studies reveal that one of every six females we treat suffers undiagnosed hypothyroidism and subsequent depression Happy brain chemicals like dopamine and serotonin lose receptivity with low thyroid T4 has very low activity and must convert to the more active T3 T4 conversion to T3 fails to occur, in both sexes, with suboptimal testosterone levels

Opiate Pain Medicine, benzodiazepines, and alcohol

Pituitary suppression of thyroid stimulation hormone (TSH)

Must measure T3 “ active thyroid ” TSH may be suppressed even though T3 T4 are low

Females are more susceptible to hypothyroidism

Florida Detox ® studies reveal that one of every six females we treat suffers undiagnosed hypothyroidism and subsequent depression

Happy brain chemicals like dopamine and serotonin lose receptivity with low thyroid

T4 has very low activity and must convert to the more active T3

T4 conversion to T3 fails to occur, in both sexes, with suboptimal testosterone levels

Growth Hormone Deficiency Reduced bone mineral density and increased risk of osteoporotic bone fractures Impaired cardiac function Central obesity Increased insulin sensitivity Reduced exercise capacity Emotional disturbances Decreased quality of life

Reduced bone mineral density and increased risk of osteoporotic bone fractures

Impaired cardiac function

Central obesity

Increased insulin sensitivity

Reduced exercise capacity

Emotional disturbances

Decreased quality of life

Testosterone Normal Levels Males: 300 – 900 ng/dL Females: 25 – 75 ng/dL

Normal Levels

Males: 300 – 900 ng/dL

Females: 25 – 75 ng/dL

OPIATE INDUCED TESTOSTERONE DEFICIENCY

OPIATE INDUCED TESTOSTERONE DEFICIENCY

OPIATE INDUCED TESTOSTERONE DEFICIENCY

OPIATE INDUCED TESTOSTERONE DEFICIENCY

Testosterone Deficiency Decreased Libido – No sex drive Bone Loss – Osteoporosis Muscle Loss - Negative nitrogen balance Fat Gain – Especially abdominal region Higher Cholesterol Levels Insulin resistance – Type II Diabetes Weak Immune System Decreased Bone Marrow Production Non-active T4 can not convert to active T3 Memory Loss Depression (Both sexes) Increased Risk of Heart Attack and Stroke

Decreased Libido – No sex drive

Bone Loss – Osteoporosis

Muscle Loss - Negative nitrogen balance

Fat Gain – Especially abdominal region

Higher Cholesterol Levels

Insulin resistance – Type II Diabetes

Weak Immune System

Decreased Bone Marrow Production

Non-active T4 can not convert to active T3

Memory Loss

Depression (Both sexes)

Increased Risk of Heart Attack and Stroke

Testosterone 2007 Harvard Study Men and women age 50 plus: Increasing testosterone levels from low normal to midrange: Male: 300 -> 600 ng/dL Female: 25 -> 50 ng/dL Reduction of both: heart attack and stroke; Males: 40% Female: 30%

2007 Harvard Study

Men and women age 50 plus:

Increasing testosterone levels from low normal to midrange:

Male: 300 -> 600 ng/dL

Female: 25 -> 50 ng/dL

Reduction of both: heart attack and stroke;

Males: 40%

Female: 30%

Daily Consumption of Pain Medication Adrenal Suppression Chronic fatigue Fibromyalgia / muscle aches Brain fog Joint pain

Adrenal Suppression

Chronic fatigue

Fibromyalgia / muscle aches

Brain fog

Joint pain

Adrenal Suppression Epinephrine deficiency Norepinephrine deficiency DHEA-s deficiency Cortisol deficiency Daily Consumption of Pain Medication

Adrenal Suppression

Epinephrine deficiency

Norepinephrine deficiency

DHEA-s deficiency

Cortisol deficiency

DHEA Deficiency Depression which is untreatable without DHEA Increased cortisol stress hormone increases anxiety,insomnia and fat accumulation Immune suppression, decreased Natural Killer Cells Decreased endorphins, increased pain Decreased human growth hormone Decreased memory

Depression which is untreatable without DHEA

Increased cortisol stress hormone increases anxiety,insomnia and fat accumulation

Immune suppression, decreased Natural Killer Cells

Decreased endorphins, increased pain

Decreased human growth hormone

Decreased memory

Florida Detox ® Drug Detoxification

Florida Detox Protocol Safe Painless Dr. Sponaugle designed detox using computerized ultrasonic heart monitor called transesophageal echocardiography

Safe

Painless

Dr. Sponaugle designed detox using computerized ultrasonic heart monitor called transesophageal echocardiography

Florida Detox Protocol Successful treatment for cardiac transplant patient addicted to Oxycontin, 3,000 mg/day Over 5,000 successful treatments Majority of chronic pain patients return to work the following week Proven Safety Convenience

Florida Detox Protocol

Successful treatment for cardiac transplant patient addicted to Oxycontin, 3,000 mg/day

Over 5,000 successful treatments

Majority of chronic pain patients return to work the following week

Opioid Withdrawal Clinical Manifestation Restlessness Irritability (Panic Attacks) Insomnia Chronic Yawning High Blood Pressure Racing Heart Nausea Vomitting Diarrhea Goose Bumps Muscle Twitching Chills Pupil Dilation Watery Eyes Runny Nose Cause: Norepinephrine Surge

Restlessness

Irritability (Panic Attacks)

Insomnia

Chronic Yawning

High Blood Pressure

Racing Heart

Nausea

Vomitting

Diarrhea

Goose Bumps

Muscle Twitching

Chills

Pupil Dilation

Watery Eyes

Runny Nose

Opiate/Alcohol/Benzodiazepine Withdrawal massive surge adrenaline (norepinephrine) from locus coeruleus during detox Locus Coeruleus Anxiety Dilated Pupils Tachycardia Tremors Sweating U R G E S Adrenaline

massive surge adrenaline (norepinephrine) from locus coeruleus during detox

Florida Detox ® Method IV medications prevent adrenaline surge normally experienced with traditional detox Locus Coeruleus Adrenaline Heart rate and blood pressure remain absolutely normal throughout the detoxification process

IV medications prevent adrenaline surge normally experienced with traditional detox