Dr. Rick Sponaugle: Chronic Pain And Addiction

CHRONIC PAINAND ADDICTIONCHRONIC PAIN

AND ADDICTION

Presented By:Presented By:

Rick Sponaugle, M.D.Board Certified AddictionologistBoard Certified Anesthesiologist& Medical Director of Florida Detox®

& Wellness Institute

Rick Sponaugle, M.D.Board Certified AddictionologistBoard Certified Anesthesiologist& Medical Director of Florida Detox®

& Wellness Institute

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WHAT IS PAIN?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

PAIN SENSITIVE BRAIN CHEMISTRY

• DOPAMINE DEFICIENCY• SEROTONIN DEFICIENCY• GABA DEFICIENCY• GLUTAMATE EXCESS• HISTAMINE EXCESS

• DOPAMINE DEFICIENCY• SEROTONIN DEFICIENCY• GABA DEFICIENCY• GLUTAMATE EXCESS• HISTAMINE EXCESS

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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

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 MEDICINEOPIOID PAIN MEDICINE

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Normal Brain Normal Brain 7 years Methadone use,

some prior Heroin

7 years Methadone use, some prior Heroin

(SPECT Brain scan from Brainplace.com, Dr. Daniel Amen)(SPECT Brain scan from Brainplace.com, Dr. Daniel Amen)

Opiates Reduce Neuronal InterconnectionsOpiates Reduce Neuronal Interconnections

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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

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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

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27 year old female: Oxycontin 300 mg/day27 year old female: Oxycontin 300 mg/day

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PLEASURE CENTER

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

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Low Dopamine D2 Receptor Activity in the Brain’s Pleasure Center Causes Depression

Low Dopamine D2 Receptor Activity in the Brain’s Pleasure Center Causes Depression

Nerve ANerve A

Nerve BNerve B

HappyReceptor

D2D2

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2005 NIDA Study2005 NIDA Study

Food Addiction

Low D2 receptor activity noted on PET scan

300 pound females have 50% less D2 activity than normal weight females

Food Addiction

Low D2 receptor activity noted on PET scan

300 pound females have 50% less D2 activity than normal weight females

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OPIOID PAIN MEDICINEOPIOID PAIN MEDICINE27 year old male from Boston presents to Florida Detox & Wellness Institute, January 2009 Drug: Oxycontin, 800 mg/dayDiagnoses: 1. ADHD

2. Over-active limbic

3. Over-active cingulate

4. Over-active basal ganglia

5. Low serotonin

6. Rule out neurotoxicity

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…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 BrainRight side – The Artistic Brain

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Pituitary gland suppression: Pituitary gland - stimulates the thyroid, adrenal glands,

testicles and ovaries.

HypothyroidismGrowth Hormone deficiencyTestosterone deficiency Estrogen deficiency Progesterone deficiencyAdrenal gland suppression

DHEA deficiency Adrenaline deficiency Cortisol deficiency

Pituitary gland suppression: Pituitary gland - stimulates the thyroid, adrenal glands,

testicles and ovaries.

HypothyroidismGrowth Hormone deficiencyTestosterone deficiency Estrogen deficiency Progesterone deficiencyAdrenal gland suppression

DHEA deficiency Adrenaline deficiency Cortisol deficiency



Hormonal AssessmentHormonal AssessmentThyroid 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

HypothyroidismHypothyroidism

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

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HypothyroidismHypothyroidismOpiate 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 DeficiencyGrowth Hormone DeficiencyReduced 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

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TestosteroneTestosterone

Normal Levels

Males: 300 – 900 ng/dL

Females: 25 – 75 ng/dL

Normal Levels

Males: 300 – 900 ng/dL

Females: 25 – 75 ng/dL

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OPIATE INDUCEDTESTOSTERONE DEFICIENCY


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Testosterone DeficiencyTestosterone 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

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TestosteroneTestosterone2007 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%

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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

Adrenal Suppression

Epinephrine deficiency

Norepinephrine deficiency

DHEA-s deficiency

Cortisol deficiency



DHEA DeficiencyDHEA DeficiencyDepression 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 memory36

Florida Detox®

Drug Detoxification

Florida Detox®

Drug Detoxification

Florida Detox Protocol 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

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Florida Detox Protocol 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

• 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 SafetyProven Safety

ConvenienceConvenience

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Opioid Withdrawal Clinical Manifestation

Opioid Withdrawal Clinical Manifestation

• Restlessness• Irritability

(Panic Attacks)• Insomnia• Chronic Yawning

• Restlessness• Irritability

(Panic Attacks)• Insomnia• Chronic Yawning

• High Blood Pressure• Racing Heart• Nausea• Vomitting• Diarrhea• Goose Bumps• Muscle Twitching• Chills

• High Blood Pressure• Racing Heart• Nausea• Vomitting• Diarrhea• Goose Bumps• Muscle Twitching• Chills

• Pupil Dilation• Watery Eyes• Runny Nose

• Pupil Dilation• Watery Eyes• Runny Nose

Cause: Norepinephrine SurgeCause: Norepinephrine Surge

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Opiate/Alcohol/Benzodiazepine Withdrawal

Opiate/Alcohol/Benzodiazepine Withdrawal

massive surge adrenaline (norepinephrine) from locus coeruleus during detoxmassive surge adrenaline (norepinephrine) from locus coeruleus during detox

Locus CoeruleusLocus Coeruleus

AnxietyAnxiety Dilated Pupils

Dilated Pupils

TachycardiaTachycardia

TremorsTremors SweatingSweating

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Florida Detox® MethodFlorida Detox® Method

IV medications prevent adrenaline surge normally experienced with traditional detox

IV medications prevent adrenaline surge normally experienced with traditional detox

Locus CoeruleusLocus Coeruleus

Heart rate and blood pressure remain absolutely normal throughout the detoxification process

Heart rate and blood pressure remain absolutely normal throughout the detoxification process

Dr. Rick Sponaugle: Chronic Pain And Addiction

Health & Medicine

Transcript of Dr. Rick Sponaugle: Chronic Pain And Addiction