substance use

Addiction

Chronic progressive brain disease w/ behavioral patterns that fall w/i a spectrum disorder

3 P’s of addiction as a brain disease

Pathological, pervasive, persistent

Does substance abuse effect one racial group more than another?

No, equal opportunity abuser

What ratio of substance abusers get treated?

1/10

MAT (medication-assisted treatment)

Use of another drug to help you detox from a drug you are addicted to

Types of MAT

Methadone, suboxone, vivitrol injection (not an opioid)

Which MAT has been best for chronic pain

Vivitrol injection (doesn’t induce opioid hyperalgesia)

How many people do you need to treat w opioids for one to be harmed?

4

How long does it take to become addicted?

3-5 days

What hormone plays a huge role in addiction

Dopamine

The brain is all about _________?

Balance

Endogenous opioids

Control sensory input

Main pleasure neurotransmitter (how we measure addictiveness)

Dopamine

Locus coeruleus (LC)

Involved in physiological response to stress and panic that happens w/ withdrawals (keep you awake when coming down from high)

How does chronic pain effect addiction?

Negatively reinforce by added stressors; increases cortisol which messes with the rewards system

Neuroplasticity

Brains capacity to change and adapt

How long does it take for dopamine receptors to heal?

3+ weeks

What is the first step to retaining the brain?

Patient buy in

What is the most common diagnosis for which opioids are prescribed?

Low back pain

Pain

Unpleasant sensory and emotional experience with actual or potential tissue damage

Pain is produced by the _____?

Brain

Nociceptive pain

Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors (ankle sprain)

Neuropathic pain

Pain caused by a lesion or disease of the somatosensory NS

Nociplastic pain

Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain

Acute pain

Pain from direct result of tissue damage or potential tissue damage and is a symptom in the 1-4 week period

Subacute pain

4-12 week period

Chronic pain

Pain that outlasts normal tissue healing time; pain that occurs in the absence of identifiable tissue damage

What is an important combination to use along with PT?

Pain neuroscience education

Does chronic pain change white or gray matter

Gray

Cortisol dump

Magnifies pain experience

What drives nociplastic pain?

Central sensitization

Central sensitization

Takes less stimulus to induce a pain response

How many people do you have to treat for one to improve one level in central sensitization