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Dr. Rick Sponaugle: Chronic Pain And Addiction


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Dr. Rick Sponaugle: on Chronic Pain And Addiction presented at the Independent Retired Football Players Summit at the South Point Resort & Casino in Las Vegas May 2009

Published in: Health & Medicine
  • Dr. Rick Sponaugle recently spoke at the NFL retired players conference. He explained why the players were feeling more pain on OxyContin than they originally felt after their initial football injury. Dr. Sponaugle explained that over time, the opiate pain medications like Roxycodone and OxyContin, distort brain chemistry, making the brain more sensitive to incoming electrical pain signals.

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Dr. Rick Sponaugle: Chronic Pain And Addiction

  1. 1. CHRONIC PAIN AND ADDICTION Presented By: Rick Sponaugle, M.D. Board Certified Addictionologist Board Certified Anesthesiologist & Medical Director of Florida Detox ® & Wellness Institute
  2. 2. WHAT IS PAIN? <ul><li>Pain: Excess electricity in the nerve </li></ul><ul><li>Example: </li></ul><ul><li>Lumbar disc pinches sciatic nerve </li></ul><ul><li>Increased electricity to brain via spinal cord </li></ul><ul><li>Electricity (pain) measured in brain (volt meter) </li></ul><ul><li>If brain chemistry optimized - less pain </li></ul>
  3. 3. PAIN SENSITIVE BRAIN CHEMISTRY <ul><li>DOPAMINE DEFICIENCY </li></ul><ul><li>SEROTONIN DEFICIENCY </li></ul><ul><li>GABA DEFICIENCY </li></ul><ul><li>GLUTAMATE EXCESS </li></ul><ul><li>HISTAMINE EXCESS </li></ul>
  4. 4. <ul><li>Pain medication like Vicodin ® and Oxycontin ® are utilized to reduce the increased electrical current from pain signals </li></ul><ul><li>Problem: These medications do not discriminate; they reduce electrical current throughout the brain and body </li></ul>OPIOID PAIN MEDICINE
  5. 5. Normal Brain (SPECT Brain scan from, Dr. Daniel Amen) 7 years Methadone use, some prior Heroin
  6. 6. 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 &quot;changes the structure of excitatory synapses. If someone constantly takes morphine, eventually it will damage the brain, change its structure and function,”
  7. 7. Daily Consumption of Pain Medication <ul><li>Decreased activity of “happy” brain chemicals Dopamine & Serotonin </li></ul><ul><li>Low serotonin activity – overactive limbic system </li></ul><ul><ul><li>brain becomes more sensitive to pain </li></ul></ul><ul><li>Low dopamine activity – underactive pleasure center </li></ul><ul><ul><li>Patient develops depression </li></ul></ul><ul><ul><li>Brain becomes more sensitive to pain </li></ul></ul><ul><li>Florida Detox - immediate correction of dopamine and serotonin deficiencies reduces pain sensitivity </li></ul>
  8. 8. 27 year old female: Oxycontin 300 mg/day
  9. 9.
  11. 11. Low Dopamine D2 Receptor Activity in the Brain’s Pleasure Center Causes Depression Nerve A Nerve B Happy Receptor D 2
  12. 12. 2005 NIDA Study <ul><li>Food Addiction </li></ul><ul><li>Low D 2 receptor activity noted on PET scan </li></ul><ul><li>300 pound females have 50% less D 2 activity than normal weight females </li></ul>
  13. 13. OPIOID PAIN MEDICINE <ul><li>27 year old male from Boston presents to Florida Detox & Wellness Institute, January 2009 </li></ul><ul><li>Drug: Oxycontin, 800 mg/day </li></ul><ul><li>Diagnoses: </li></ul><ul><ul><li>ADHD </li></ul></ul><ul><ul><li>Over-active limbic </li></ul></ul><ul><ul><li>Over-active cingulate </li></ul></ul><ul><ul><li>Over-active basal ganglia </li></ul></ul><ul><ul><li>Low serotonin </li></ul></ul><ul><ul><li>Rule out neurotoxicity </li></ul></ul>
  14. 14. … Two months after detox, Dr. Sponaugle referred patient to Amen Clinic because medical history positive for severe brain trauma
  15. 16.
  16. 17. <ul><li>The left brain process information in logical analytical stages </li></ul>
  17. 18. <ul><li>Right side – The Artistic Brain </li></ul>
  18. 19.
  19. 20. <ul><li>Pituitary gland suppression: </li></ul><ul><ul><li>P ituitary gland - stimulates the thyroid , adrenal glands , testicles and ovaries . </li></ul></ul><ul><li>Hypothyroidism </li></ul><ul><li>Growth Hormone deficiency </li></ul><ul><li>Testosterone deficiency </li></ul><ul><li>Estrogen deficiency </li></ul><ul><li>Progesterone deficiency </li></ul><ul><li>Adrenal gland suppression </li></ul><ul><ul><ul><li>DHEA deficiency </li></ul></ul></ul><ul><ul><ul><li>Adrenaline deficiency </li></ul></ul></ul><ul><ul><ul><li>Cortisol deficiency </li></ul></ul></ul>Daily Consumption of Pain Medication
  20. 21. Hormonal Assessment <ul><li>Thyroid Function </li></ul><ul><ul><li>TSH Free T3 & Free T4 </li></ul></ul><ul><li>Testosterone </li></ul><ul><li>Estradiol </li></ul><ul><li>Progesterone </li></ul><ul><li>DHEA-s </li></ul><ul><li>LH FSH </li></ul><ul><li>ACTH & Cortisol </li></ul><ul><li>Growth Hormone </li></ul>
  21. 22. Hypothyroidism <ul><li>Depression </li></ul><ul><li>Fatigue </li></ul><ul><li>Cold intolerance </li></ul><ul><li>Memory problems </li></ul><ul><li>Dry skin </li></ul><ul><li>Weight gain </li></ul><ul><li>High cholesterol </li></ul><ul><li>High blood sugar </li></ul><ul><li>Constipation </li></ul>
  22. 23. Hypothyroidism <ul><li>Opiate Pain Medicine, benzodiazepines, and alcohol </li></ul><ul><ul><li>Pituitary suppression of thyroid stimulation hormone (TSH) </li></ul></ul><ul><ul><li>Must measure T3 “ active thyroid ” TSH may be suppressed even though T3 T4 are low </li></ul></ul><ul><ul><li>Females are more susceptible to hypothyroidism </li></ul></ul><ul><ul><ul><li>Florida Detox ® studies reveal that one of every six females we treat suffers undiagnosed hypothyroidism and subsequent depression </li></ul></ul></ul><ul><ul><li>Happy brain chemicals like dopamine and serotonin lose receptivity with low thyroid </li></ul></ul><ul><ul><li>T4 has very low activity and must convert to the more active T3 </li></ul></ul><ul><ul><li>T4 conversion to T3 fails to occur, in both sexes, with suboptimal testosterone levels </li></ul></ul>
  23. 24.
  24. 25. Growth Hormone Deficiency <ul><ul><li>Reduced bone mineral density and increased risk of osteoporotic bone fractures </li></ul></ul><ul><ul><li>Impaired cardiac function </li></ul></ul><ul><ul><li>Central obesity </li></ul></ul><ul><ul><li>Increased insulin sensitivity </li></ul></ul><ul><ul><li>Reduced exercise capacity </li></ul></ul><ul><ul><li>Emotional disturbances </li></ul></ul><ul><ul><li>Decreased quality of life </li></ul></ul>
  25. 26. Testosterone <ul><li>Normal Levels </li></ul><ul><ul><li>Males: 300 – 900 ng/dL </li></ul></ul><ul><ul><li>Females: 25 – 75 ng/dL </li></ul></ul>
  30. 31. Testosterone Deficiency <ul><li>Decreased Libido – No sex drive </li></ul><ul><li>Bone Loss – Osteoporosis </li></ul><ul><li>Muscle Loss - Negative nitrogen balance </li></ul><ul><li>Fat Gain – Especially abdominal region </li></ul><ul><li>Higher Cholesterol Levels </li></ul><ul><li>Insulin resistance – Type II Diabetes </li></ul><ul><li>Weak Immune System </li></ul><ul><li>Decreased Bone Marrow Production </li></ul><ul><li>Non-active T4 can not convert to active T3 </li></ul><ul><li>Memory Loss </li></ul><ul><li>Depression (Both sexes) </li></ul><ul><li>Increased Risk of Heart Attack and Stroke </li></ul>
  31. 32. Testosterone <ul><li>2007 Harvard Study </li></ul><ul><li>Men and women age 50 plus: </li></ul><ul><ul><li>Increasing testosterone levels from low normal to midrange: </li></ul></ul><ul><ul><ul><li>Male: 300 -> 600 ng/dL </li></ul></ul></ul><ul><ul><ul><li>Female: 25 -> 50 ng/dL </li></ul></ul></ul><ul><li>Reduction of both: heart attack and stroke; </li></ul><ul><ul><ul><li>Males: 40% </li></ul></ul></ul><ul><ul><ul><li>Female: 30% </li></ul></ul></ul>
  32. 33. Daily Consumption of Pain Medication <ul><li>Adrenal Suppression </li></ul><ul><li>Chronic fatigue </li></ul><ul><li>Fibromyalgia / muscle aches </li></ul><ul><li>Brain fog </li></ul><ul><li>Joint pain </li></ul>
  33. 34. <ul><li>Adrenal Suppression </li></ul><ul><li>Epinephrine deficiency </li></ul><ul><li>Norepinephrine deficiency </li></ul><ul><li>DHEA-s deficiency </li></ul><ul><li>Cortisol deficiency </li></ul>Daily Consumption of Pain Medication
  34. 35.
  35. 36. DHEA Deficiency <ul><li>Depression which is untreatable without DHEA </li></ul><ul><li>Increased cortisol stress hormone increases anxiety,insomnia and fat accumulation </li></ul><ul><li>Immune suppression, decreased Natural Killer Cells </li></ul><ul><li>Decreased endorphins, increased pain </li></ul><ul><li>Decreased human growth hormone </li></ul><ul><li>Decreased memory </li></ul>
  36. 37. Florida Detox ® Drug Detoxification
  37. 38. Florida Detox Protocol <ul><li>Safe </li></ul><ul><li>Painless </li></ul><ul><li>Dr. Sponaugle designed detox using computerized ultrasonic heart monitor called transesophageal echocardiography </li></ul>
  38. 39. <ul><li>Florida Detox Protocol </li></ul><ul><li>Successful treatment for cardiac transplant patient addicted to Oxycontin, 3,000 mg/day </li></ul><ul><li>Over 5,000 successful treatments </li></ul><ul><li>Majority of chronic pain patients return to work the following week </li></ul>Proven Safety Convenience
  39. 40. Opioid Withdrawal Clinical Manifestation <ul><li>Restlessness </li></ul><ul><li>Irritability (Panic Attacks) </li></ul><ul><li>Insomnia </li></ul><ul><li>Chronic Yawning </li></ul><ul><li>High Blood Pressure </li></ul><ul><li>Racing Heart </li></ul><ul><li>Nausea </li></ul><ul><li>Vomitting </li></ul><ul><li>Diarrhea </li></ul><ul><li>Goose Bumps </li></ul><ul><li>Muscle Twitching </li></ul><ul><li>Chills </li></ul><ul><li>Pupil Dilation </li></ul><ul><li>Watery Eyes </li></ul><ul><li>Runny Nose </li></ul>Cause: Norepinephrine Surge
  40. 41. Opiate/Alcohol/Benzodiazepine Withdrawal <ul><li>massive surge adrenaline (norepinephrine) from locus coeruleus during detox </li></ul>Locus Coeruleus Anxiety Dilated Pupils Tachycardia Tremors Sweating U R G E S Adrenaline
  41. 42. Florida Detox ® Method <ul><li>IV medications prevent adrenaline surge normally experienced with traditional detox </li></ul>Locus Coeruleus Adrenaline Heart rate and blood pressure remain absolutely normal throughout the detoxification process