NEUROAURICOLOTHERAPY FOR OPIOID ABUSE IN CHRONIC BENIGN PAIN

E. Fanzago | Anesthesiologist and Pain Therapist, Torino

BACKGROUND
By Law no. 38 as of 2010, in Italy we achieved great progress regarding acute and chronic pain control. It was mandatory to alleviate sufferance in patients without creating negative side effects due to the therapeutic drugs. Opioids were recognized as having an important role in the treatment of both cancer pain and benign chronic pain. However, over the years, we realized their "oversized" use, compromising the general well-being especially in patients with a long-life expectancy, even inducing a paradoxical hyperalgesia. Even before noticing it in Italy, since the 90s up to our days, particularly in the USA, we have noticed an inappropriate use of Morphine, Fentanyl and their derivates with negative effects and pathologies as Opioids Use Disorder (OUD) or Opioids Addiction difficult to control, particularly in predisposed patients.
METHODS
According to Prof. David Alimi's neuroauricolotherapy studies, since 2019, I have decided to treat my patients, after their accurate consent, with this technique in association with mild analgesics and antidepressants, to control their chronic benign pain and to wean them from the abuse of Opiates which had created unpleasant side effects. In the case of Opioid Use Disorder (OUD), the neurotransmitters and cerebral structures involved are the endorphinic ones (amygdala, locus ceruleus, periaqueductal gray matter) and dopaminergic ones (arcuate nucleus) as well as the thalamic one. The therapeutic strategy consists in slowly eliminate opioids and sedatives, replacing them with neuroauricolar sessions for pain control by stimulating the four pain filters “points” (gate control-reticular-thalamus-cortex). The relaxation triad is added plus a biochemical detoxification treatment. Local anesthetic infiltration of the trigger points or mesotherapy are allowed. At home, as a “rescue therapy”, only very low doses of mild anti-inflammatory painkillers (paracetamol, ketoprofen). The treatment was performed after the request of the patients with single needles and/or semi-permanent ones (ASPn). The chronic benign pain was present for at least six months. The first two sessions were performed at a distance of one week, then every three weeks.
RESULTS AND DISCUSSION
Two and a half months after the first visit, all the patients stopped the drugs that caused them various types of disorders, without significant withdrawal symptoms; they showed a good pain control (VAS 2 on movement) and a fair improvement in sleep. The follow-up was done one year later without resumption of addiction.
CONCLUSIONS
Up to now, the evidence highlights that opioids are not the first-line therapy for chronic benign pain and in case of acute pain is advisable not to treat for a long time. Neuroauriculotherapy can help in opioid addiction, providing pain relief while offering greater safety. However, further studies are required.