The American College of Osteopathic Family Physicians is accredited by the American Osteopathic Association Council to sponsor continuing medical education for osteopathic physicians.

The American College of Osteopathic Family Physicians designates the lectures and workshops for Category 1-A credits on an hour-for-hour basis, pending approval by the AOA CCME, ACOFP is not responsible for the content.

ACOFP / AOA’s 122nd Annual Osteopathic Medical Conference & Exposition

OCTOBER 7 - 10PHILADELPHIA, PENNSYLVANIA29.5 Category 1-A CME credits anticipated

OMED 17®

Joint Session with ACOFP, ACONP and AOAAM: Pain and Addiction

Gary Ruelas, DO, PhD

10/2/2017

1

PAIN AND ADDICTIONTHE ROAD TO RECOVERY

What is about opiates and drugs, that lets individuals such as these, experience briefly a world of bliss, independent of the reality of their world?

10/2/2017

2

Or individuals such as these…believing

That they look like this

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3

OUR PRESENT MODELS OF CARE MAY BE

Too limiting!!! We may be….

asking, for someone who is addicted to an opiate and is use to driving down a highway like this..

10/2/2017

4

TO GO UP A PATH SUCH AS THIS… DAILY!!!!

It might be prudent to ask ourselves questions such as:• Are we asking the right questions?

• Are we looking at in the right places?

• Are we helping to change lives or perpetuating the same cycle?

10/2/2017

5

Let’s Review what we are up against…

A QUICK REVIEW OF THE NEUROBIOLOGY OF PAIN

REMEMBER, PAIN…TRAVELS

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6

PHYSIOLOGICAL PAIN ENTERS THE SPINAL TRACT FROM PERIPHERAL NERVES

10/2/2017

7

Quick Review Of The Neurobiology of Pain and Addiction

• WHERE ARE THE MAJORITY OF RECEPTORS THAT INTERFACE WITH PAIN AND ADDICITON?

THEY ARE FOUND AND INTERFACE HERE…..

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MORE SPECIFICALLY HERE…………………………

How does pain play a role in addiction:

• Addiction: is the biological drive to alleviate (physiological and emotional pain), complicated by a diminishing efficacy but increased dependency on a substance that has inherent biological and sociological harm.

• There is a compulsive need for and use of a habit-forming substance (such as heroin, cocaine, sedatives, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly :

• And a persistent compulsive use of a substance known by the user to be harmful.

10/2/2017

9

THE RECURRENT CIRCUIT OF ADDICTION

DIFFERENCE BETWEEN PAIN MANAGEMENT AND ADDICTION• Usually there is known physical damage

• There is a point of satiation (most likely due to the damage being treated)

• There is a maintenance level arrived at… and therefore can be managed.

• There maybe an adequate support system in place to help with management and support for pain management…..more on this later..

As opposed to:

No (known physical) DAMAGE

No satiation (poly substance abuse etc., and recurrent abuse is likely)

There is often limited support system

Therefore there may be difficulty with maintenance levels.

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10

Let’s quickly reviewThe Neurobiology of Pleasure and Pain

• Which perhaps is a reflection of the neurobiology of recovery

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Neurobiology of connection/recovery

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12

Vassopressin

These Two Regulating Molecules….

• Oxytocin and vasopressin help to regulate the amygdala

• Released by the paraventricular and supraoptic nuclei of the hypothalamus..

• Function as neuropeptides

• Oxytocin inhibits the amygdala

• Vasopressin stimulates the amygdala

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13

A few areas that are deactivated by oxytocinand other states of well being….include:• Amygdala

• Frontal cortex

• Prefrontal cortex

• Temporal poles

• Parietotemporal junction

SO OUR MODELS OF CARE NEED TO GET TO THE MID BRAIN• Methods to get to mid brain:

• Medications: including partial opiate agonist, anti depressants, mood stabilizers, blockers.

• Neurofeedback (QEEG)

10/2/2017

14

Brain withdrawing from Amphetamine before and after Neurofeedback

• Trans Cortical Magnetic Stimulation….

10/2/2017

15

BUT BY THEMSELVES?????

Ok…however relationships…relationships..relationships..

Connections..connections…connections.

Support, Support..Support