How does it work?The physiological basis for Dry Needling

 

Anything physiological has to do with the body and its systems. You might notice that your physiological response to a scary movie includes your heart beating faster and your hands getting sweaty.

You know that the root word of physiological is phys, which refers to the body (think of those phys. ed. classes you panted through). That root comes from the Greek word for nature. Add the suffix ology, which means “the study of” (see where we’re going?), and finally, tack on that little ical. Ta-taa! You have turned the root into an adjective to describe the way your body works. Let’s get physiological!

The physiological basis for DN depends upon the targeted tissue and treatment objectives.

The treatment of myofascial trigger points (referred to as TrPs) has a different physiological basis than treatment of excessive muscle tension, scar tissue, fascia, and connective tissues. TrPs are hyperirritable spots within a taut band of contractured skeletal muscle fibers that produce local and/or referred pain when stimulated. TrPs are divided into active and latent TrPs dependent upon the degree of irritability.

Active TrPs are spontaneously painful, while latent TrPs are only painful when stimulated, for example, with digital pressure. TrPs can be visualized by magnetic resonance imaging and sonography elastography, Which has shown that active TrPs are larger than latent TrPs and feature a reduction in circulation.

TrPs are physiological contractures, characterized by local ischemia and hypoxia, a significantly lowered pH (active TRPs only), a chemically altered milieu (active TRPs only), local and referred pain, and altered muscle activation patterns.

Although latent TrPs are not spontaneously painful, recent research has shown that they do contribute to nociception, therefore they need to be included in the treatment plan. TrPs are associated with dysfunctional motor endplates, endplate noise, and an increased release of acetylcholine. TrPs activate muscle nociceptors and are peripheral sources of persistent nociceptive input, thus contributing to the development of peripheral and central sensitization.

Stimulation of TrPs activates the periaqueductal grey and anterior cingular cortex in the brain,  and enkaphalinergic, serotonergic, and noradrenergic inhibitory systems associated with A-δ (A delta) fibers through segmental inhibition. DN can be divided into deep and superficial DN.

Deep DN has been shown to inactivate TrPs , which are modulated by the central nervous system. DN has been shown to be associated with alleviation and mitigation of spontaneous electrical activity or motor endplate noise ;a reduction of the concentration of numerous nociceptive, inflammatory, and immune system related chemicals; and relaxation of the taut band. Deep DN of TrPs is associated with reduced local and referred pain, improved range of motion, and decreased TrP irritability both locally and more remotely. DN normalizes the chemical milieu and pH of skeletal muscle and restores the local circulation.

Superficial DN is thought to activate mechanoreceptors coupled to slow conducting unmyelinated C fiber afferents, and indirectly, stimulate the anterior cingular cortex. Superficial DN may also be mediated through stimulation of A-δ fibers, or via stretching of fibroblasts in connective tissue. Superficial DN is associated with reduced local and referred pain and improved range of motion, but it is not known at this time whether superficial DN has any impact on normalizing the chemical environment of active TrPs or reducing motor endplate noise associated with TrPs in general.

The physiological basis for DN treatment of excessive muscle tension, scar tissue, fascia, and connective tissues is not as well described in the literature, but the available research shows that there may be several benefits. Muscle tension is determined by a combination of the basic viscoelastic properties of a muscle and its surrounding fascia, and the degree of activation of the contractile apparatus of the muscle. There is some evidence that excessive muscle tension, as seen for example in spasticity, can be alleviated with DN.

Scar tissue has been linked to myofascial pain and fibroblasts. Fibroblasts are specialized contractile cells within the fascia that are of particular interest, as they synthesize, organize, and remodel collagen, dependent upon the tension between the extracellular matrix and the cell. DN, especially when used in combination with rotation of the needle, can place fibroblasts in a high tension matrix, at which point the fibroblast changes shape and assumes a lamellar shape, and increases its collagen synthesis and cell proliferation. DN has been shown to directly activate fibroblasts through mechanical manipulation of the needle, which in turn activates the release of cytokines and other pro-inflammatory mediators. DN can play a substantial role in the process of mechanotransduction, which is described as the process by which the body converts mechanical loading into cellular responses. Fibroblast activation with a solid filament has been shown to result in pain neuromodulation.

file:///C:/Users/User/Documents/Research%20papers/DryNeedlingInClinicalPractice_ResourcePaper.pdf

 

What is Dry Needling?

Dry Needling, What does it do?

Dry needling reduces pain,  and is great in the treatment for acute and chronic injuries, and where needling procedures are described for a range of neuro-musculoskeletal diagnoses, e.g., osteoarthritis, low back pain and migraine.

Dry needling is a ‘skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying TrPs, muscles and connective tissues for the management of both neuro-musculoskeletal pain and movement impairments .  Administered to altered or dysfunctional tissues in order to improve or restore function. This may include (but is not limited to) needling of myofascial TrPs, periosteum and connective tissues.

Myotherapy and Massage we uses  the twisting method which has been proven to be the better technique. Read more

Precautions

There are certain precautions to be considered with the use of DN:

1. Patients with a needle aversion or phobia may object to the physical therapy treatment with DN. With appropriate education, however, these patients may still consider DN.

2. Patients with significant cognitive impairment may have difficulty understanding the treatment parameters and DN intervention.

3. Patients who are unable to communicate directly or via an interpreter may not be appropriate for DN treatments.

4. Patients may not be willing to be treated with DN.  Caution is warranted with younger patients. Based on empirical evidence, DN is not recommended for children younger than 12 years of age. When treating children, DN should only be performed with parent and child’s consent. Care should be taken assuming a child understands the procedure.

.5. Patients need to be able to give consent for the treatment with DN.

6. Local skin lesions must be avoided with DN.

7. Local or systemic infections are generally considered to be contraindicated.

(Systemic means affecting the entire body, rather than a single organ or body part. For example, An infection that is in the bloodstream is called a systemic infection.) Sepsis and the common cold is an example of a systemic infection.

8. Local lymphedema (note: there is no evidence that DN would cause or contribute to increased lymphedema, ie, postmastectomy, and as such is not a contraindication).

9. Severe hyperalgesia or allodynia may interfere with the application of DN, but should not be considered an absolute contraindication.

10. Some patients may be allergic to certain metals in the needle, such as nickel or chromium. This situation can easily be remedied by using silver or gold plated needles.

11. Patients with an abnormal bleeding tendency, ie, patients on anticoagulant therapy or with thrombocytopenia, must be needled with caution. DN of deep muscles, such as the lateral pterygoid or psoas major muscle, that cannot be approached with direct pressure to create hemostasis may need to be avoided to prevent excessive bleeding.

12. Patients with a compromised immune system may be more susceptible to local or systemic infections from DN, even though there is no documented increased risk of infection with DN.110

13. DN during the first trimester of pregnancy, during which miscarriage is fairly common, must be approached with caution, even though there is no evidence that DN has any potential abortifacient effects.111-113

14. DN should not be used in the presence of vascular disease, including varicose veins.

15. Caution is warranted with DN following surgical procedures where the joint capsule has been opened. Although septic arthritis is a concern, DN can still be performed as long as the needle is not directed toward the joint or implant. (Additional consideration needs to include implanted devices, pacemakers and cosmetic implants as performing TrP-DN in these areas is contraindicated.)

How does it work? 

Dry Needling, Pistoning versus twisting the needle

Which is more effective?

Twisting of course!

There are two types of methods,

  • Pistoning, which involves moving the needle in and out, in a fan shape motion.
  • Twisting,  which is placing the needle onto the site and gently twisting the fibres around the needle.

at Myotherapy and Massage we use  the twisting method which has been proven to be the better technique.

Myofascial trigger point (MTrP) injection and trigger point dry needling (TrPDN) are widely accepted therapies for myofascial pain syndrome (MPS). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential.

According to a recent narrative review, there is a sizeable consensus that elicitation of a Local Twitch Response( LTR ), provides greater immediate and long-term pain relief with needling therapy than no Local Twitch Response (Shah et al., 2015).

However, this assumption is based on very limited research and relies predominantly on clinical observation.

Dry needling to elicit LTRs is a commonly used technique to treat Myofascial TrPoint Syndrome for the management of Myofacial Pain Syndrome; the benefits of needle manipulation via needle rotation or winding of connective tissue, rather than repeated pistoning directly into muscular trigger points, is well supported in the literature. In addition, the number of needle insertions during “pistoning” at one insertion site appears to positively correlate with levels of post-needling soreness, increased levels of inflammation within muscle fibers, and mechanical injury at or near the neuromuscular junction. In addition, TrPDN using needle rotation (i.e. unidirectional or bidirectional winding) and manual MTrP techniques have been shown to elicit neurophysiological responses that can positively alter the MTrP status and reduce pain without the need for a LTR. Therefore, the LTR during TrPDN appears unnecessary and may not be required for managing myofascial pain and may be unrelated to many of the positive effects of dry needling. However, further investigation is required.

How?

TrPDN also helps elicit spinal segmental pain inhibitory effects (Mejuto-Vazquez et al., 2014Srbely et al., 2010) and descending pain control pathways (Niddam et al., 2007) that may not rely on eliciting LTRs. Strong needle stimulation via winding stimulates the release endogenous opioids, which is considered one of the most potent mechanisms for pain suppression in the periphery and at the spinal cord level secondary to needling treatment (Chou et al., 2012Zhang et al., 2014). Hsieh et al. (2016) demonstrated that needling distal but segmentally related MTrPs induced increases in enkephalin at the spinal dorsal horn and β-endorphin in the serum and dorsal root ganglion neurons. In addition, endogenous opioids were markedly increased in the proximal muscle in proportion to needle dosage (Hsieh et al., 2016). Most importantly, this study used slow and gentle needle insertion with rotation to MTrPs during a 30 s period and did not report eliciting a LTR (Hsieh et al., 2016). In clinical studies, deep needle stimulation to muscular afferents at acupuncture points and MTrPs with needle rotation, not multiple rapid insertions at the same entry point and with the same needle, demonstrated a superior treatment effect that persisted at 3 month follow up compared to superficial needling in subjects with chronic shoulder (Ceccheerelli et al., 2001) and lumbar myofascial pain (Ceccherelli et al., 2002),

respectively.http://www.bodyworkmovementtherapies.com/article/S1360-8592(17)30031-1/fulltext

 

 

Cupping

There are myriad versions of Cupping including – Stationary (Retaining) Cupping, Needle Cupping, Moxa Cupping, Water Cupping, Wet Cupping, Flash Cupping, Herbal Cupping, Aquatic Cupping, Massage Cupping, Intermittent Cupping and Dynamic Cupping.
When movement is involved this type of Cupping Therapy is also known as Koppingsmassage, Sugekopsmassage, Body Vacuuming, Pneumatic Therapy, Cupping Massage, Glide Cupping, Dredging the Channels,  Running Cups, Negative Pressure Massage, Migrating Cups and the Moving Cup Method.

At Myotherapy and Massage we use Myofacial Cupping.   It is used to to stretch myofacia, to loosen its tensile hold which can contribute to tension in the tissue and is used over trigger points to releive associated pain or referred pain 

 

Lymphatic Drainage

What is The Lymphatic System

The extraordinary workings of the lymphatic system make blood circulation look simple by comparison. Made up of fine vessels and lymph nodes, this little-known circulation is an important part of the immune system. It quietly goes about its business, filtering out waste and debris, and carrying nutrients to cells.

The lymph nodes do the collection and filtering of waste material from cell fluid, while the lymph vessels return the fluid back to the general circulation.  It clears the entire body, stopping excess fluid from lying around in the tissues.  It always heads towards the heart.

Unlike the heart, lymph doesn’t have a pump to push it round the body.  It relies mainly on our muscular action and body movement to keep the fluid moving.  As well, it needs all areas of the body to be in good condition; that means adequate fluid intake, excellent nutrition and high level well-being.

What Goes Wrong

When the lymphatic system doesn’t work efficiently, the tell-tale signs of oedema or tight swollen tissue appear.  A common instance is seen after a long-distance air travel: ankles and legs become tight and puffy. It’s due to lack of movement, pressure on lymph vessels from sitting, and the hanging position of the legs.  Medical conditions can also be the cause of oedema. But as well, by the end of winter, after too little exercise, too much starchy food, and far too many hot chocolates, our bodies may be pretty sluggish and longing for a fresh start to get that fluid moving.

What is Lymphatic Drainage?

When you intervene and encourage the fluid to drain properly, it’s known as lymphatic drainage. You can jazz up your whole system with a treatment, whether or not you have fluid retention.  It can be a stand-alone procedure, or it can be incorporated into a massage treatment.  You can even do it yourself.

All treatments are not the same; it depends on the condition being treated, but the aim is always to get the fluid moving out of the tissue and towards the heart.

 

What Can It Be Used For?

A surprising number of conditions respond to lymphatic drainage. If a medical condition is involved, you should consult your practitioner first:

  • Swollen ankles and legs after air travel
  • Tight sore breasts – PMT or fibrocystic disease
  • Headache
  • Medical conditions – after removal of lymph nodes
  • Following cosmetic surgery – liposuction, scar tissue

    Reasons for Poor Lymphatic Flow

    Poor lifestyle choices are the commonest causes of an inefficient lymphatic system, though they are certainly not the only ones.

    • Lack of exercise – lymphatic fluid needs muscle power to push it round the body
    • Poor diet – may increase congestion and produce more waste for the lymph to pick up and dispose of
    • Pollutants – environmental and dietary
    • Surgery and trauma
    • Pregnancy

    Major Benefits of Lymphatic Drainage

    Every part of the body is influenced by the lymphatic system, because no matter what the purpose of the cells, they all need nourishing and cleaning.

    It’s important in immunity, inflammation and healing in general, so an efficient lymphatic system is going to help in many areas.  Lymphatic drainage is a way to achieve that efficiency.

    • Skin care: For a clearer complexion and to lessen the appearance of fine lines and wrinkles in facial tissue, as well as reducing puffiness around the eyes.
      Old scar tissue can be reduced while the appearance of new scars can be minimized. It’s commonly used before and after cosmetic surgery.
    • Detox: At the end of winter, or after a period of high stress, the body will really benefit from lymphatic drainage, to reduce the sluggishness brought on by too many starchy, high fat foods and too little exercise.
    • Headache: Most headaches including sinusitis have a component of congestion that responds well to   lymphatic drainage.   Once tissue is decongested, blocked fluid and blood flow improve, reducing pain and discomfort.
    • Promote healing: After surgery or injury, the tissue may be swollen and sore. Lymphatic drainage is a gentle treatment that will help drain the tissue, reduce inflammation and improve healing.
    • Pregnancy and after: There is often fluid retention in pregnant women and lymphatic drainage can improve comfort especially in legs and feet.  Breast feeding will be enhanced by this treatment, especially when there are problems with blocked ducts and sore tight breasts.
    • Reduce swelling: After long periods of immobility such as air travel or lessened mobility, fluid tends to stagnate in the tissue making it puffy and tender.
      Conditions such as arthritis often have joints that are congested with fluid. All of these respond well when fluid is reduced with lymphatic drainage.
    • Relaxation: Because it is such a gentle treatment, it is one of the most relaxing.  And the relaxation is enhanced as the cleansing and rejuvenating effects relieve stress.

    Most people will notice improvements in their level of wellbeing after a treatment because lymphatic drainage has so many benefits.  Keep yourself looking and feeling in tip-top condition with a regular session.

 

Pregnancy Massage

Therapeutic massage has been used for centuries to improve overall health, reduce stress, and relieve muscle tension.

Studies indicate that massage therapy performed during pregnancy can reduce anxiety, decrease symptoms of depression, relieve muscle aches and joint pains, and improve labor outcomes and newborn health. Massage therapy addresses different needs through varying techniques, one of which is called Swedish Massage.

Swedish Massage aims to relax muscle tension and improve lymphatic and blood circulation through mild pressure applied to the muscle groups of the body. Swedish Massage is the recommended massage method during pregnancy.

Other potential benefits of prenatal massage:

  • Reduced back pain
  • Reduced joint pain
  • Improved circulation
  • Reduced edema
  • Reduced muscle tension and headaches
  • Reduced stress and anxiety
  • Improved oxygenation of soft tissues and muscles
  • Better sleep

4 Benefits of Remedial Therapy

When I Initially came to Cheryl I was off work with painful spasms down the side of my trunk, with recommendations from the doctor I went to a remedial therapist for my back pain. Cheryl cured me that day and I returned to work the next day, I have other issues too which I have had for a while, with my right shoulder, Cheryl tested all the muscles in the shoulder and also found carpel tunnel in my wrists and also found some issues with my left hip Cheryl has helped me resolve my shoulder and given me some great advice. I will be back, as she has me feeling wonderful and optimistic for the future”.Jan

1. Assist a wide variety of health disorders

Remedial massage therapists are trained to assess the body, observe changes and design individual treatment plans for each client. In addition to correcting any injuries, postural or joint issues, regular treatments also assist in helping a wide variety of health disorders. This includes insomnia, anxiety, back pain, headache and a variety of chronic pain throughout the body.

2. Reduced stress

One of the most noted effects of massage is a greater feeling of relaxation, both physically and emotionally. Remedial massage therapy encourages the release of endorphins that reduce stress levels and promotes relaxation, while reducing the production of stress-inducing hormones such as adrenaline, cortisol and norepinephrine.

3. Greater sporting performance

Remedial massage therapies are focused on repairing muscles and tendons that have been damaged, knotted or impaired in any way – majority of which are a result of undertaking sporting activity.

In enhancing recovery and decreasing recovery time, remedial massage can thereby improve athletic performance at all levels.

4. Alleviation of recurrent pain

Whether it’s back pain, headaches or stiff joints, there are some recurring pains that won’t go away despite our best efforts. Regular remedial massage treatments CAN HELP. Based on individual assessments and regular post-treatment monitoring.  Cheryl can help determine if Remedial  Massage is the best treatment option for you

Everyone benefits from massage, especially for general relaxation or muscle tension caused by exercise or lifestyle activities.

Once you see what great benefit massage is you will want one as often as you can.  Making it part of your well being routine, same as regular exercise like doing yoga and eating right  are all GREAT lifestyle choices to be the best you can be. 

Make the time; 1 hour each week or fortnight  especially if you suffer from chronic musco-skeletal pain or tension headaches, lower back pain and stiffness or similar, or if you are an athelete.  

Remedial Therapy will guide the body to faster recovery. Helping direct more attention to areas in need.  Bringing circulation back to those tightened muscles and aiding in detoxifying, and loosening the body with modalities including lymphatic drainage, deep tissue, trigger point therapy, myofascial release, mobilization and ties it all together with warming Swedish techniques.Remedial

The body is a wonderful mechanism, be kind to it

Stress and the brain

What do you do to reduce your stress levels?

Studies have shown that massage triggers the relaxation response, taking your body off alert and setting in motion the biological processors needed to restore your resources and reverse the physical processors of fight or flight.

Massage calms the nervous system, and helps you to relax and unwind. It relieves muscle tension, increases circulation clearing accumulated stress hormones and waste products, bathing your cells in nutrients vital for tissue repair.

It also increases oxygen to the brain, which many benefits include clearer cognitive function. You will sleep better too.

The more regular your massage the better your body will learn to relax.

 

Todays stress is often ambiguous and ongoing, and you become less and less able to unwind.

Muscle tension can develop into problems, such as chronic headaches or shoulder and back pain, which themselves are stressful.

Worry and physical tension can interfere with sleep, leaving you exhausted with little energy or mental focus to tackle your problems.
You may even find your normal coping strategies add stress to your struggle to find time to exercise and social engagements

As pressure mounts the level of stress hormones in your bloodstream can become so high, that very little is needed to trigger a stress response.

Here is a little TED video that goes for about 4 min 15 seconds on  what Stress does to the brain:

 

STRESS AND THE BRAIN

https://www.facebook.com/TEDEducation/videos/1127655593914312/

General Exercise Guidelines to stay fit

When it comes to exercise, the benefits far outweigh the risks. A program of regular exercise – beyond activities of daily living – is essential for most adults.”

The basic recommendations – categorized by cardiorespiratory exercise, resistance exercise, flexibility exercise and neuromotor exercise – are as follows:

Cardiorespiratory Exercise

  • Adults should get at least 150 minutes of moderate-intensity exercise per week.
  • Exercise recommendations can be met through 30-60 minutes of moderate-intensity exercise (five days per week) or 20-60 minutes of vigorous-intensity exercise (three days per week).
  • One continuous session and multiple shorter sessions (of at least 10 minutes) are both acceptable to accumulate desired amount of daily exercise.
  • Gradual progression of exercise time, frequency and intensity is recommended for best adherence and least injury risk.
  • People unable to meet these minimums can still benefit from some activity.

Resistance Exercise

  • Adults should train each major muscle group two or three days each week using a variety of exercises and equipment.
  • Very light or light intensity is best for older persons or previously sedentary adults starting exercise.
  • Two to four sets of each exercise will help adults improve strength and power.
  • For each exercise, 8-12 repetitions improve strength and power, 10-15 repetitions improve strength in middle-age and older persons starting exercise, and 15-20 repetitions improve muscular endurance.
  • Adults should wait at least 48 hours between resistance training sessions.

Flexibility Exercise

  • Adults should do flexibility exercises at least two or three days each week to improve range of motion.
  • Each stretch should be held for 10-30 seconds to the point of tightness or slight discomfort.
  • Repeat each stretch two to four times, accumulating 60 seconds per stretch.
  • Static, dynamic, ballistic and PNF stretches are all effective.
  • Flexibility exercise is most effective when the muscle is warm. Try light aerobic activity or a hot bath to warm the muscles before stretching.

Neuromotor Exercise

  • Neuromotor exercise (sometimes called “functional fitness training”) is recommended for two or three days per week.
  • Exercises should involve motor skills (balance, agility, coordination and gait), proprioceptive exercise training and multifaceted activities (tai ji and yoga) to improve physical function and prevent falls in older adults.
  • 20-30 minutes per day is appropriate for neuromotor exercise.

In addition to outlining basic recommendations and their scientific reasoning, the position stand also clarifies these new points:

  • Pedometers, step-counting devices used to measure physical activity, are not an accurate measure of exercise quality and should not be used as the sole measure of physical activity.
  • Though exercise protects against heart disease, it is still possible for active adults to develop heart problems. All adults must be able to recognize the warning signs of heart disease, and all health care providers should ask patients about these symptoms.
  • Sedentary behavior – sitting for long periods of time – is distinct from physical activity and has been shown to be a health risk in itself. Meeting the guidelines for physical activity does not make up for a sedentary lifestyle.

“It is no longer enough to consider whether an individual engages in adequate amounts of weekly exercise,” said Garber, who is an associate professor of movement sciences at the Teachers College of Columbia University. “We also need to determine how much time a person spends in sedentary pursuits, like watching television or working on a computer. Health-and-fitness professionals must be concerned with these activities as well.”

The position stand’s purpose is to offer health-and-fitness professionals scientific, evidence-based recommendations that help them customize exercise prescriptions for healthy adults. The position stand is published in the July 2011 issue of Medicine & Science in Sports & Exercise®, the official journal of ACSM. To access this position stand, visit http://www.acsm-msse.org/.

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The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 45,000 international, national and regional members and certified professionals are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

Medicine & Science in Sports & Exercise® is the official journal of the American College of Sports Medicine and is available from Lippincott Williams & Wilkins at 1-800-638-6423. To speak with a leading sports medicine expert on the topic, contact the department of communications and public information at 317-637-9200, ext. 133 or 127. Visit ACSM online at www.acsm.org.

Opoids and Pain

 

Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids. The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli. The type of pain experienced might be the same as the underlying pain or might be different from the original underlying pain.

In a recent study, “A comprehensive review of opioid-induced hyperalgesia.”

OIH appears to be a distinct, definable, and characteristic phenomenon that could explain loss of opioid efficacy in some patients. Clinicians should suspect OIH when opioid treatment’s effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the original pain, and increased levels of pain with increasing dosages. The treatment involves reducing the opioid dosage, tapering them off, or supplementation with NMDA receptor modulators.

https://www.ncbi.nlm.nih.gov/pubmed/21412369/

In a study in Oregan, people who had spinal surgery that were on Opoids for pain before going into surgery still needed them after surgery and in fact did not stop taking them. Deyo and colleagues studied nearly 2,500 adults who underwent lumbar spine (lower back) fusion surgery in Oregon, using the state’s prescription drug monitoring program to quantify opioid use before and after the surgery. They defined long-term postoperative use as more than four prescriptions filled in the seven months following the surgery, with at least three prescriptions filled more than 30 days after the surgery. They found that 1,045 patients received long-term opioids before surgery and 1,094 received them after surgery. Among the long-term users, 77 percent continued long-term use and 14 percent had episodic use. About 9 percent discontinued using opioids or only used them shortly after surgery.

As part of the analysis, Deyo and colleagues found that the prescription dose before surgery was the strongest predictor of long-term use after surgery.

“It’s not fair to say that continued use represents failure of the surgery, but instead, it represents poor transitions of care and a failure to coordinate care for patients,” said Dr. Chad Brummett of the University of Michigan Medical School, who was not involved in the study.

Brummett and colleagues launched the Michigan Opioid Prescribing Engagement Network in 2016 to develop a preventive approach to the opioid epidemic in the state. They plan to tailor opioid prescriptions in the post-surgery and acute care settings.

“For those using opioids and seeking surgery to cure the pain, it’s critical to work with your doctor to wean you down, both before and after surgery,” SOURCE: bit.ly/2pKd3bK PAIN, online March 6, 2018.

When you develop a resistance to these drugs you tend to take more and the effects continue to become less. Then if you happen to take yourself off them or reduce them  your resistance goes down.  A factor that contributes to overdose is going back on them at the increased dose you once were at before coming down on them.  It is important to work with your doctor in any situation and not take dosage into your own hands.

One final word about opoids,  more than 30 percent of overdoses involving opioids also involve benzodiazepines, a type of prescription sedative commonly prescribed for anxiety or to help with insomnia. … Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), among others. Its important not to mix doses

Combining opioids and benzodiazepines can be unsafe because both types of drug sedate users and suppress breathing—the cause of overdose fatality—in addition to impairing cognitive functions. In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzodiazepinesUnfortunately, many people are prescribed both drugs simultaneously. A recent study showed that people concurrently using both drugs are at higher risk of visiting the emergency department or being admitted to a hospital for a drug-related emergency.

Previous studies have also highlighted the dangers of co-prescribing opioids and benzodiazepines. A cohort study in North Carolina found that the overdose death rate among patients receiving both types of medications was 10 times higher than among those only receiving opioids.In a study of overdose deaths in people prescribed opioids for noncancer pain in Canada, 60 percent also tested positive for benzodiazepines.  Ptients should consult with their doctors about the potential dangers of using various medications and substances together, including the use of alcohol.

https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids