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28.07.2014
Related Products (5)Neurofeedback is a cutting-edge, drug-free therapeutic technique used by over a thousand licensed therapists in North America to treat a range of conditions from attention deficit and hyperactivity disorders to epilepsy, stroke, anxiety, migraine, and depression. Being in recovery from addiction is, in many ways, like being in recovery from diabetes, heart disease or other chronic health conditions. In response to surgeries, injuries or chronic pain, standard protocol for doctors is to write up a prescription for a narcotic pain reliever such as Vicodin, Percodan or OxyContin.
According to the National Health Interview Survey, 3.1 million Americans reported using acupuncture in 2007 – the highest number ever reported. Scientific research hasn’t proven the exact mechanism that makes acupuncture effective, but experts believe it may release pain-numbing chemicals in the body or block pain signals coming from the nervous system.
Chiropractors use spinal manipulation and other approaches to align the body and enable it to heal without the need for medication or surgery. For people struggling with arthritis, headaches, fibromyalgia and other chronic conditions, pain relief sometimes can be achieved through physical therapy. Certain vitamins and dietary supplements have been reported to ease pain, though studies show mixed results. Stress is a significant contributor to pain as well as a wide range of other emotional and physical ailments.
Some of the most effective stress management techniques include yoga, massage, meditation, tai chi, and biofeedback.
If you’re struggling with chronic pain, studies show there’s a good chance you’re also battling depression. One non-addictive pain medication that works for certain people is neurontin, also known as gabapentin. In many cases, pain can be treated with anti-inflammatory drugs such as prescription-strength ibuprofen (except chronic pain, since aspirin and ibuprofen can impair stomach and liver function over time). If anti-inflammatory drugs aren’t sufficient and you’ve exhausted the alternatives, your doctor may be able to prescribe a painkiller that is less addictive and longer acting than those traditionally offered. DrugRehab.usDrug Rehab is a comprehensive site on the various types of drug rehabs, what to look for when seeking treatment, and information about addiction.
The most common form of PDPN is chronic or persistent sensorimotor neuropathy, which is abnormalities in feeling and movement due to nerve damage. A study in 2003 looked at health care costs of PN in the United States and found the cost of treating PN at that time to be nearly $11 billion. In addition to strict glycemic control, pain medications are needed for the treatment of PDPN.
Antidepressants: Tricyclic antidepressants (TCAs) have been the most studied drug class for PDPN. TCAs have a high incidence of adverse effects, especially anticholinergic effects, and warnings for their use include the presence of arrhythmias, myocardial infarction (MI), glaucoma, and urinary retention. See TABLE 1 for recommended doses, time to effect, and generic availability of antidepressants used in the treatment of PDPN. Because there are few drug classes to treat PDPN, elderly patients with PDPN often use TCAs or other inappropriate pain medications.
Venlafaxine (Effexor) has also been studied for the treatment of PDPN.17 It is a potent inhibitor of neuronal serotonin reuptake, and at higher doses it also inhibits norepinephrine reuptake.
Adverse events are less frequent with venlafaxine compared to TCAs, and the most common include sleep disturbance (27%-46%), headache (25%-34%), and nausea (21%-58%). Duloxetine (Cymbalta) has also been studied for the treatment of PDPN and was the first FDA-approved agent in its treatment.18,19 It is a balanced inhibitor of both serotonin and norepinephrine transporters. Common adverse events include sleep disturbances (15%-26%), nausea (4%-22%), dizziness (1%-14%), and headache (13%). Antiepileptics: There are several antiepileptic agents that have been studied for the treatment of PDPN. The proposed mechanism of action of carbamazepine (CBZ) for PDPN is its peripheral blockade of sodium channels on the A-gamma nerve fibers. Gabapentin's most common side effects include sedation (20%), dizziness (17%-28%), ataxia (13%), and fatigue (11%).
Lamotrigine (Lamictal) is another antiepileptic medication that works peripherally and acts as a sodium channel blocker. Lamotrigine's common side effects include sedation (9%), fatigue (8%), dizziness (7%), nausea (7%-14%), and abnormal vision (2%-5%). Pregabalin has many common side effects, including dizziness (8%-45%), somnolence (4%-28%), ataxia (up to 20%), peripheral edema (up to 16%), weight gain (up to 16%), dry mouth (1%-15%), headache (up to 14%), blurred vision (1%-12%), and tremor (up to 11%).
Topiramate (Topamax) is a peripherally acting sodium channel blocker, and it acts at the GABA receptor. Topiramate has many adverse effects, including somnolence (15%-29%), fatigue (9%-30%), dizziness (4%-32%), cognitive slowing (3%-21%), and confusion (4%-14%). In addition to safety and efficacy, cost should also be considered if choosing an antiepileptic agent for the elderly. Other Pharmacologic Agents: Other agents (and their characteristics) that can be used for the treatment of PDPN are listed in TABLE 2.
All patients with neuropathy should be considered at risk of a foot ulcer and require frequent foot exams, education in routine foot care, and regular podiatric assessments.32 Pharmacists can provide patients with information regarding the essentials of good foot care.
Alternative drug rehab could refer to many types of rehabs, but often refers to the philosophical spirit of a drug rehab treatment program.


Alternative addiction treatment is often a good choice for someone who feels alienated by traditional methods, or who has specific spiritual beliefs that they believe are important to their recovery.
There are drug rehabs that are hybrids with a strong clinical program with evidence-based practices that also offer alternative therapies and treatments.  These rehabs will offer the latest tools such as biofeedback and EMDR, but will also offer therapies that strengthen the body and spirit, such as yoga and acupuncture.
Equine-assisted psychotherapy is being offered by specialty drug rehabs, and has been shown to be particularly effective for people who are resistant to traditional talk therapy or those who have had multiple failed treatments in the past. If you have a history of relapse or failed treatments, or if you have left treatment early in the past, you might consider researching alternative drug rehabs to see if you can find a program that will be more effective for you.
First popularized in the 1970s, this naturalistic method is based on the idea that we can control our brain activity and that, through training, the brain can learn to modify its own electrical patterns for more efficient processing or to overcome various states of dysfunction.In Biofeedback for the Brain, Dr.
Mainstream medicine has embraced acupuncture and other forms of complementary and alternative medicine (CAM), with some of the nation’s best drug rehabilitation programs offering acupuncture and other holistic therapies.
Acupuncture is often used in combination with other approaches as part of a broader pain relief strategy. But research shows that regular physical activity can boost energy, improve mood, build bone density, keep joints flexible, strengthen muscles and relieve chronic pain.
Physical therapists teach patients how to cope with pain on a daily basis by building up strength and endurance, improving range of motion, and enhancing flexibility in the muscles and joints. Limiting saturated fats and eating more fruits, vegetables and whole grains can boost the immune system and improve overall well-being. Examples include capsaicin, which is derived from chili peppers and may help with arthritis and diabetic nerve pain, and fish oil to reduce inflammation. High doses of certain vitamins can thin the blood or result in nerve or organ damage, and even natural herbal remedies can interact with other medications in harmful ways. According to the 2007 National Health Interview Survey, nearly 40 percent of participants reported using CAM in the past 12 months (most commonly meditation, massage and acupuncture).
Many of these services are offered at the best drug rehabs and can be continued with a local provider after completing treatment. Left untreated, each condition can worsen the other so it is important to talk with a counselor to promote healing in both areas.
Originally developed to control seizures in people with epilepsy, it has also been found to be effective for some types of chronic pain such as that caused by damage to nerves.
You’ll need to become a strong advocate for your own recovery, refusing to take mind-altering substances whenever possible and working with a doctor who understands the special needs of patients in addiction recovery.
If you end up taking some form of prescription painkiller, you will need to minimize the dose and length of drug therapy, intensify your involvement in a recovery support program, and work closely with your doctor to vigilantly monitor the course of treatment. In fact, allowing pain to continue unabated slows the healing process, can lead to depression, anxiety and sleep disturbances, and is itself a significant risk factor for relapse. PN is slow in onset and may be present in up 10% of patients at the time of T2DM diagnosis. Antidepressants and antiepileptics are the main drugs that have been studied and used to treat PDPN. Venlafaxine has the potential to increase blood pressure and heart rate, so these vital signs should be monitored. See TABLE 1 for recommended doses, time to effect, and generic availability of antiepileptics used in the treatment of PDPN. More typical side effects include dizziness (44%), sedation (32%), nausea (29%), and headache (22%). It also has rare, serious side effects, such as aplastic anemia and toxic epidermal necrolysis.
It works peripherally on the gamma-aminobutyric acid (GABA) receptors, which help block the perception of pain. There did not seem to be a specific demographic subgroup of patients who were at a higher risk, but the risk was higher in patients with epilepsy compared to patients on an antiepileptic for other conditions. The American Society of Pain Educators published consensus guidelines in 2006 for the treatment of PDPN. Experts state that elderly patients find biofeedback useful for the treatment of diabetic neuropathy, intermittent claudication, and arthritis. An alternative drug rehab might combine Native American healing with group therapy and equine therapy for example.
However, it is still important to embrace some traditional methods of treatment that are evidence-based and have been shown to be effective, such as traditional group therapy. Common procedures like dental surgery or health complaints like back pain, while unpleasant for most, require extra precautions for those in recovery. Although it may not be effective for all types of pain, studies suggest that acupuncture is an effective pain reliever for many conditions, including sports injuries, back pain, fibromyalgia, chronic pain and arthritis.
Start with a short walk most days of the week and gradually increase the intensity with guidance from your doctor.
Chiropractic care also can be beneficial for those suffering from neck pain, sports injuries, repetitive strains, arthritis and headaches.
A number of drug rehabilitation programs offer nutraceutical therapy, or you can get recommendations from a nutritionist or registered dietitian.
While not all stress management techniques are effective for all types of pain, studies show that CAM therapies alleviate pain, sometimes even more effectively than traditional approaches.
Cognitive-behavioral therapy and support groups have proven particularly beneficial for stress reduction, anxiety, depression and other emotional issues that perpetuate pain.


Find a doctor who specializes in addiction (an “addictionologist”) and talk to them about whether non-addictive medications will be safe and effective in your particular situation. By avoiding addictive drugs whenever possible and exploring some of these alternative avenues of pain relief, you can manage your pain without jeopardizing your recovery. The tertiary amines--amitriptyline and imipramine--are nonselective and provide balanced inhibition of both neurotransmitters. The tertiary amines are metabolized by and inhibit more CYP450 enzymes than the secondary amines and therefore have a greater potential for drug interactions.
Of the TCAs used, amitriptyline was prescribed 84% of the time, nortriptyline 14%, and imipramine 2%. Contraindications include TCA hypersensitivity, bone marrow suppression, recent use of MAOIs, and pregnancy. It is also associated with thrombocytopenia, pancreatitis, aplastic anemia, and toxic epidermal necrolysis. Its drug recommendations were based on the number of randomized, controlled trials that show efficacy. Counseling points regarding drug therapy should include potential side effects and when to expect benefit.
When drug treatment is needed, TCAs are more efficacious and less expensive than most other options, but their side effects make them an unfavorable choice in the elderly.
The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. The management of persistent pain in older persons: AGS panel on persistent pain in older persons. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.
Use of potentially inappropriate pain-related medications in older adults with painful neuropathic disorders. Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain.
Percutaneous electrical nerve stimulation: a novel analgesic therapy for diabetic neuropathic pain.
Static magnetic field therapy for symptomatic diabetic neuropathy: a randomized double-blind placebo-controlled trial. Low-intensity laser therapy for painful symptom diabetic sensorimotor polyneuropathy: a controlled trial. Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy: a double-blind placebo-controlled study with monochromatic infrared treatment. Often an alternative drug rehab will be in a natural or unique setting, such as on a ranch or in the wilderness. The secondary amines, nortriptyline and desipramine, provide more reuptake of norepinephrine.
It is contraindicated in heart failure, in hypertension, and with thiazolidinediones (due to potential additive effects on weight gain and edema, especially in patients with prior cardiovascular disease). Contraindications include hepatic dysfunction, urea cycle disorders, pregnancy, and concurrent use of topiramate. With numerous actual case examples, readers follow the progress of clients from the initial “brain map” that shows the location and severity of the neurological abnormalities to the various stages of treatment.
Common medications that would be affected by concurrent administration include theophylline and warfarin.
With Medicare Part D, elderly patients can more easily afford medications, such as duloxetine and pregabalin.
Conditions often considered untreatable by conventional health practitioners respond positively to neurotherapeutic treatment and Swingle describes many of these remarkable recoveries. Other chapters describe the use of neurotherapy for a variety of surprising purposes, including performance training for elite athletes, of which the most famous example is the Italian soccer team who considered the technique to be their “secret weapon” in attaining a World Cup victory. Despite wide-ranging success stories and the endorsement of the American Psychological Association, many health care practitioners remain skeptical of neurofeedback and the procedures are still not well-known by the public or conventional health care providers. The topical preparations may be viable options for elderly patients who cannot tolerate the recommended oral medications due to side effects or drug interactions. The complexity of capsaicin application (wearing gloves, four times a day dosing, very painful for first week of use) may limit its use.
Neurofeedback is the only alternative nondrug therapy that has shown benefit in reducing neuropathic pain in the elderly; however, finding clinics that provide this type of therapy and that accept insurance or Medicare can be problematic.
If an analgesic such as tramadol or an opioid is considered, one must keep in mind the abuse potential.



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