Days Of Rehabilitation Research Articles

Apoptotic changes in lymphocytes of protein energy malnutrition patients

Detection of the apoptotic cellular changes of lymphocytes in protein energy malnutrition (PEM) and correlating these findings to increased incidence of infection in PEM were the main objectives of this study. The studied malnourished infants (15 edematous and 15 nonedematous) and 10 healthy controls were subjected to medical history, clinical examination, and routine laboratory workup besides estimation of cellular apoptotic changes using flow cytometry. Infants were re-evaluated after 30 days of nutritional rehabilitation. All apoptotic indices were higher in malnourished cases compared with the controls and normalized after nutritional rehabilitation. Positive significant correlation was found between the rate of infection and the early apoptotic cell percent in both groups of patients before nutritional rehabilitation. In conclusion, the abnormalities of lymphocytes in PEM are not only limited to their abnormal count or disturbed subsets ratio but also include enhanced apoptosis of their peripheral forms which may explain many of the associated abnormalities in PEM. This apoptotic derangement is reversible by implementing an early nutritional rehabilitation program.

Intestinal Barrier Function and Weight Gain in Malnourished Children Taking Glutamine Supplemented Enteral Formula

We examined the effect of standard formula and glutamine or glycine supplemented enteral formula on intestinal permeability and weight gain in children with malnutrition. 80 children aged 2 to 60 months with a weight-for-age z-score less than -- 2 were studied. From December 1996 to April 1999, 27 study patients received nonsupplemented formula. From June 2001 to June 2002 an additional 53 patients were randomly assigned to receive formula supplemented with glutamine or glycine (isosmolar concentrations) for 10 days. Lactulose/mannitol excretion ratio was used as a measure of intestinal permeability and was performed before and after 10 days of nutritional rehabilitation. Weight was measured before and after treatment. Patients were similar on admission with regard to age, sex, nutritional status and lactulose/mannitol ratio. The lactulose/mannitol ratio significantly improved (decreased) in children receiving formula supplemented with glutamine for 10 days but not in those receiving glycine or nonsupplemented formula. Weight gain occurred during therapy in all groups and was not statistically different among groups. Formula supplemented with glutamine improves intestinal barrier function compared with nonsupplemented formula but does not augment weight gain.

Comparison of Concurrent and Retrospective Pain Ratings during Rehabilitation Following Anterior Cruciate Ligament Reconstruction

The accuracy of retrospective ratings of pain intensity was examined in a sample of 72 men and 36 women undergoing rehabilitation following anterior cruciate ligament (ACL) reconstructive surgery. Participants completed daily ratings of current, worst, and average pain intensity for the first 42 days of rehabilitation. Participants provided retrospective ratings of worst and average pain intensity twice for a 7-day period (on Days 7 and 21) and once for a 30-day period (on Day 30). Correlations between concurrent and retrospective pain ranged from .74 to .88. Retrospective pain ratings consistently overestimated concurrent pain ratings, but were generally not biased by current pain. The results suggest that retrospective pain ratings can substitute for concurrent pain ratings if the tendency toward overestimation is taken into account.

Plasma precursors of brain catecholaminergic and serotonergic neurotransmitters in rehabilitation patients with ischemic stroke

Aquilani R, Verri M, Iadarola P, Arcidiaco P, Boschi F, Dossena M, Sessarego P, Scocchi M, Arrigoni N, Pastoris O. Plasma precursors of brain catecholaminergic and serotonergic neurotransmitters in rehabilitation patients with ischemic stroke. Arch Phys Med Rehabil 2004;85:779–84. Objective To determine levels of plasma amino acid tyrosine and tryptophan, precursors of brain catecholamine and serotonin neurotransmitters, respectively, in rehabilitative patients with ischemic stroke. Design Controlled, pre-post analysis, consecutive sample. Setting Rehabilitation center. Participants Twenty men with ischemic stroke (age, 68±11.3y) consecutively admitted into rehabilitation 15±10 days (range, 7–28d) after an acute cerebrovascular insult; 15 healthy sedentary subjects (controls 1); and 13 healthy hypoactive individuals who had recently had knee arthroplasty (controls 2). Both control groups were matched to stroke subjects for age, gender, and body weight. Interventions At 8:00 am, after overnight fasting, venous blood samples were drawn from patients to determine plasma tyrosine and tryptophan levels. A nutritional evaluation, including nitrogen balance, was made. The same procedures were repeated after 45 days of rehabilitation. Amino acid data were compared with those obtained from the controls. Main outcome measure Plasma concentrations of amino acids. Results Patients with ischemic stroke, on admission, had lower plasma tyrosine concentration than did both controls 1 ( P<.0005) and controls 2 ( P<.001), but a similar tryptophan level. The plasma content of tyrosine was similar between the 2 control groups. After 45 days of rehabilitation, the stroke patients’ tyrosine and tryptophan levels remained virtually unchanged, as did nutritional parameters. Nutritional intakes were adequate to meet body needs but insufficient to correct plasma tyrosine. Conclusions Patients experiencing a recent stroke may have low plasma tyrosine levels and, therefore, reduced brain catecholamine formation. It is possible that an imbalance of brain neurotransmitters may occur.

Test-retest reliability of an abbreviated self-report overall health status measure.

Test-retest reliability study. To assess test-retest reliability and estimate minimal detectable change of an overall measure and 2 summary measures of patient self-report of health status. Change in patient self-report of health status is a common outcome measure following rehabilitation. Because collection of health status data takes time and clinicians are required to be productive, selected items from reliable instruments were used to form a new, abbreviated instrument of health status relevant to patients in outpatient rehabilitation. There are no test-retest reliability statistics of these health status measures in this population. A convenience sample of 71 patients (mean age +/- SD, 41.9 +/- 17.9 years; age range, 15-83 years; sex, 35% male), with a variety of orthopaedic diagnoses, seeking rehabilitation in 2 outpatient facilities, volunteered. Patients completed health status questionnaires at initial evaluation and at 24 to 72 hours following evaluation. Intraclass correlation coefficients (ICC2.1) were used to estimate test-retest reliability and to estimate measurement error and minimal detectable changes. ICCs with a 1-sided lower limit 95% confidence intervals (CI) of the Overall Health Status measure and the Physical and Mental Component Summary measures for patients with chronic symptoms were 0.92 (0.85), 0.82 (0.68), and 0.85 (0.74), respectively. Minimal detectable changes (90% CI) were +/-12 (scale range, 100), +/- 9 (scale range, 60), and +/- 9 (scale range, 60) scale points, respectively, for the same measures. Results support the test-retest reliability of the Overall Health Status measure and summary measures for patients with chronic symptoms and demonstrate ability of the Overall Health Status and Physical Summary Scale measures to detect improvement of patient self-report of health status within the first few days of rehabilitation.

Poster 166: Bilateral thigh pain after unilateral deep brain stimulator placement: a case report.

Setting: Rehabilitation hospital. Patient: An 81-year-old right-handed woman with bilateral essential tremor. Case Description: The patient underwent deep brain stimulator placement in the ventral intermediate nucleus of the left thalamus at another institution to treat right-sided tremor. The procedure was complicated by injury to the anomalous left subclavian artery. Left upper-extremity arterial emboli resulted and required open thrombectomies. The postoperative course was notable for confusion attributed to anesthesia and urinary tract infection. Because of ongoing functional deficits (patient required moderate assistance with dressing and bathing and minimum assistance to ambulate 75ft with an assistive device), the patient was admitted to inpatient rehabilitation on postoperative day 10 from stimulator placement. On admission to rehabilitation, she complained of bilateral thigh pain, which had developed during hospitalization. The aching thigh pain disrupted sleep and therapies and did not respond to anti-inflammatory, narcotic, or neuropathic pain medications. Lumbar spine imaging revealed degenerative disease without foraminal stenosis. Electromyography of the lower extremities was normal. Head computed tomography confirmed stimulator placement in the left thalamus. Assessment/Results: Bilateral thigh pain resolved after the deep brain stimulator frequency was increased to control upper-extremity tremor. Pain medications were subsequently discontinued successfully. The patient was discharged to home at a modified independence level and could ambulate >1000ft after 22 days of inpatient rehabilitation. Discussion: Complications associated with deep brain stimulator placement can cause functional impairments requiring rehabilitation, and physiatrists should be familiar with side effects associated with deep brain stimulation (DBS). Although parasthesias are a known side effect of deep brain stimulator placement, discomfort is typically treated by decreasing stimulation. This is the first reported case, to our knowledge, of bilateral pain from unilateral DBS that responded to increased frequency of stimulation. Conclusions: Unilateral DBS can cause bilateral pain; increasing DBS frequency can relieve pain.

Exercise prescription based on heart rate: a simple thing or a science?

Introduction Since the early days of cardiac rehabilitation (CR), exercise has been the predominant component of structured programmes. Over the past years, CR units have advanced towards comprehensive secondary prevention institutions, and in the same way, the role of exercise after a heart attack has changed. Whereas initially, the main emphasis was put on supervised familiarization of daily activities and the resumption of strenuous physical activity further during the course of the programme, today CR programmes aim to ensure an enjoyable exercise experience and to use exercise as a motivator of lifestyle changes. At any time, the role of exercise and accordingly exercise prescription, was to improve fitness and overall health in a safe manner.

The rigidity of repaired flexor tendons increases following ex vivo cyclic loading

Transected flexor tendons are typically treated by suture repair followed by rehabilitation that generates repetitive tendon loading. Recent results in an in vivo canine model indicate that during the first 10 days after injury and repair, there is an increase in the rigidity of the tendon repair site. Our objective was to determine whether or not ex vivo cyclic loading of repaired flexor tendons causes a similar increase in repair-site rigidity. We simulated 10 days of rehabilitation by applying 6000 loading cycles to repaired canine flexor tendons ex vivo at force levels generated during passive motion rehabilitation; we then evaluated their tensile mechanical properties. High-force (peak force, 17 N) cyclic loading increased repair-site rigidity by 100% and decreased repair-site strain by 50%, whereas low-force (5 N) loading did not change the properties of the repair site. This mechanical conditioning effect may explain, in part, the changes in tensile properties observed after only 10 days of healing in vivo. Mechanical conditioning of repaired flexor tendons by repetitive forces applied during rehabilitation may lead to increases in repair-site rigidity and decreases in strain, thereby altering the mechanical loading environment of tissues and cells at the repair site.

Endoscopic therapy of pre-patellar bursitis

Prepatellar bursitis often results from sport-specific activities (e.g. wrestling, soccer, volleyball or ice hockey) or from work-related injuries (e.g. concrete finishing). In such cases, when conservative therapy is not successful, the bursa must be openly removed. Over a period of five years, our clinic conducted a total of 22 arthroscopic bursectomies. The following describes the endoscopic surgery, the postoperative clinical treatment and the results of the associated therapy. A follow-up examination of 22 patients were clinically revealed as successful operation. In one case a recurring bursitis was diagnosed, which deemed necessary an open bursectomy. Six of the patients were professional-caliber athletes (wrestlers, soccer and ice hockey players) and were able to return to their competitive sports following 24 days of rehabilitation. The average return-to-work time was 18 days. It is our opinion that endoscopic bursectomy of bursitis prepatellaris is a less radical and promising technique, given the fact that it can be performed an on out-patient basis using local anaesthesia.

Hip fracture in patients with Alzheimer's disease

The purpose of this study was to evaluate the outcome of hip fracture repair and rehabilitation in patients with Alzheimer's disease. A retrospective study of patients with Alzheimer's disease, who sustained hip fracture repair during the years 1992 and 1993 was done. All patients were living in the community and were followed in the Memory Disorder Institute (MDI) in a large community hospital. A total of nineteen patients with dementia had sustained a hipfracture and 14 patients met the criteria of probable Alzheimer's disease. Five patients were excluded due to non Alzheimer's type of dementia. Surgical hip repair was performed in 13 patients. One patient refused surgery. All patients had 10 days of rehabilitation for ambulation. Patients who needed longer rehabilitation were transferred to a rehabilitation center. Post operative findings include the fact that all 14 patients were able to ambulate 25 feet with assistance in the rehabilitation department (including a patient who refused surgical repair). One month follow-up after hospital discharge reveals that patients with pre-hip fracture Mini-Mental Status (MMSE) equal or below 15 (total of 9 patients), were unable to ambulate with any assistance. There were four patients with MMSE &gt; 15. Three were able to ambulate after hip surgical repair (with or without assistance), although one patient was non ambulatory. Interestingly, even the patient who refused surgical repair (MMSE = 10), was able to ambulate 50 feet with a walker while in the hospital After discharge to her home, she was unable to ambulate. Our findings suggest that none of the patients with Alzheimer's disease and MMSE ≤ 15, who sustained hip fracture repair were able to ambulate one month after hospital discharge.

Clinical and clinical laboratory correlates in sea otters dying unexpectedly in rehabilitation centers following the Exxon Valdez oil spill.

Following the Exxon Valdez oil spill, 347 oiled sea otters (Enhydra lutris) were treated in rehabilitation centers. Of these, 116 died, 94 within 10 days of presentation. Clinical records of 21 otters dying during the first 10 days of rehabilitation were reviewed to define the laboratory abnormalities and clinical syndromes associated with these unexpected deaths. The most common terminal syndrome was shock characterized by hypothermia, lethargy, and often hemorrhagic diarrhea. In heavily and moderately oiled otters, shock developed within 48 hours of initial presentation, whereas in lightly oiled otters shock generally occurred during the second week of captivity. Accompanying laboratory abnormalities included leukopenia with increased numbers of immature neutrophils (degenerative left shift), lymphopenia, anemia, azotemia (primarily prerenal), hyperkalemia, hypoproteinemia/hypoalbuminemia, elevations of serum transaminases, and hypoglycemia. Shock associated with hemorrhagic diarrhea probably occurred either as a direct primary effect of oiling or as an indirect effect secondary to confinement and handling in the rehabilitation centers. Lightly oiled otters were less likely to die from shock than were heavily oiled otters (22% vs. 72%, respectively). Heavily oiled otters developed shock more rapidly and had greater numbers of laboratory abnormalities, suggesting that exposure to oil was an important contributing factor.

Benefits of physical activity in the prevention of cardiovascular diseases.

Today it is undisputed that physical exercise and sports activity have beneficial effects in the prevention of cardiovascular diseases. Heberden, who in 1772 brilliantly described the clinical manifestations of angina pectoris, anticipated the benefits of physical exercise when he asked whether "chopping wood for 30 min every day would not be a remedy." These beneficial effects have been demonstrated in primary and in secondary prevention after a heart attack or coronary event. Physical rehabilitation enables patients to recuperate quickly, and provides optimal conditions for their reintegration into professional, social, and family life after a temporary incapacity. Since the days of Heberden, physical exercise and rehabilitation of the cardiac patient have acquired great importance in the fight against the risk factors for atherosclerosis, owing to their practical importance and to the many research problems they provoke. The European Society of Cardiology, the French Society of Cardiology, the European Federations, and the French Federation of Cardiology have unanimously recognized the theoretical and practical importance of this issue, and each of these organizations has formed a working group, undertaken clinical research, or assisted cardiac patients with counseling. The Fifth World Congress, held at Bordeaux in 1992, has confirmed the importance of the topics in cardiology that are discussed here. The aim of this general review is to analyze the benefits obtained from physical activity on cardiovascular function, and, in the light of the most recent and important studies, to discuss the effects of physical exercise in the primary and secondary prevention of cardiovascular diseases, particularly of coronary atherosclerosis.

Socialization to the Culture of a Rehabilitation Hospital: An Ethnographic Study

Most previous research on rehabilitation of patients after spinal cord injuries has dealt with the attainment of outcomes valued by staff members or with the prediction of successful outcomes based on sociodemographic characteristics of patients. This study examined the rehabilitation process from the insider's perspective of an individual patient to determine his view of important adaptive problems and to examine how these problems were addressed. Ethnographic methods were used for fine-grained documentation of the experiences of one 30-year-old man with spinal cord injury. Daily interview were conducted with this patient during his 116 days of inpatient rehabilitation. An interdisciplinary research team analyzed the data with the constant comparative method to identify a number of recurring themes. Findings indicate that in addition to learning how to function in the local world of the rehabilitation hospital, the patient also learned a new identify as a person with a long-term disability. A central theme was the patient's ongoing attempt to figure out how his future was related to his life before the injury and how he could use previous competencies in adapting to disability. Staff members seemed so intent on teaching the patient new skills that they often discounted the significance of his past experience and failed to engage in helping the patient connect his future life story to his past.

Effect of folic acid deficiency upon lymphocyte subsets from lymphoid organs in mice

1. 1. Three groups of weanling C57BL/6 female mice were fed one of two folate-deficient diets (0 and 0.1 mg folic acid/kg diet) or a normal folate-containing diet (2 mg folic acid/kg diet) for 8 weeks. A control pair-fed group was introduced with the most severe folate-deficient diet. Seven mice were fed the 0 mg folic acid/kg diet for 8 weeks, then rehabilitated (R) on the 2mg folic acid/kg diet for 10 days. 2. 2. Mice fed 0 mg folic acid/kg diet were severely folate-deficient (SFD), whereas mice fed 0.1 mg folic acid/kg diet were moderately folate-deficient (MFD), as shown by their folate status parameters. 3. 3. Thymus weight, thymocyte content and positive immature CD4 +8 + cells were decreased in SFD mice compared to controls. These values were normalized after 10 days of rehabilitation. 4. 4. Mesenteric lymph node cells were apparently not affected by folate deficiency. 5. 5. The proportion of Thy-1 + splenocytes was mildly lower in SFD mice than in controls. In R mice, mean spleen weight and spleen cellularity were increased compared to the other groups, but the proportions of Thy-1 +, CD4 +8 − and CD4 −8 + cells were markedly lower than control values.

Neonatal thyroid deficiency has differential effects on cell specific markers for astrocytes and oligodendrocytes in the rat brain

The effects of thyroid deficiency on the activity of glutamine synthetase (GS) and the number of glial fibrillary acidic (GFA) protein containing cells (the markers for astroglial cells) and on the 2′, 3′-cyclic nucleotide 3′-phosphohydrolase (CNPase) activity (the marker for oligodendroglial cells) were studied in the cerebral cortex, hippocampus and cerebellum of the rat at ages 5, 10, 15 and 25 days, and at day 130 following 102 days of rehabilitation. In the cerebral cortex and hippocampus of control rats, the activity of GS was relatively greater at 5 days and during development it increased earlier than in the cerebellum. The reverse was true for CNPase activity, which during maturation increased earlier in the cerebellum than in the cerebral cortex and hippocampus. Neonatal thyroid deficiency resulted in exactly opposite effects on the marker enzymes for astroglial and oligodendroglial cells: the developmental patterns of GS activity were transiently advanced, while those of CNPase were markedly retarded in all three brain regions. In agreement with the biochemical findings on GS activity, the morphological observations also showed a marked increase in the density of cells containing GFA protein in the different brain regions of 15 day old hypothyroid rats. In the cerebral cortex and hippocampus, in spite of continued thyroid hormone deficiency, the rise in GS activity was restored to normal by 25 days, whereas in the cerebellum the elevation of enzyme activity was restored to normal only after rehabilitation. On the other hand, the effect of neonatal thyroid deficiency on the CNPase activity was more severe in the cerebral cortex and hippocampus than in the cerebellum. In this brain part, the decrease in CNPase activity was restored to normal after a long period of hormonal rehabilitation, but, in comparison with controls, it remained persistently reduced in the cerebral cortex and hippocampus. The present observations, together with our previous findings, would indicate that the effect of thyroid hormone on the maturation of neural cells is cell-type specific. Furthermore, it is proposed that, consistent with the suggestion that astrocytes promote differentiation of nerve cells, the observed hyperplasia and hypertrophy of astrocytes may represent a compensatory response to the marked retardation in neuronal maturation in the hypothyroid rats.

Long chain fatty acid deficits in brain myelin sphingolipids of undernourished rat pups.

A restricted maternal dietary intake (40% of ad libitum intake) is known to cause myelin deficit that is accompanied by decreased amounts of individual phospholipids and sphingolipids in brain myelin of suckling rats. This communication reports the effects of the same nutritional stress on the fatty acid composition of brain myelin lipids. In myelin of 19-day-old normally fed rats, palmitate (16:0), stearate (18:0) and oleate (18:1) accounted for 80-90% of all fatty acids in phosphatidylcholine, phosphatidylethanolamine and phosphatidylserine. Maternal dietary restriction resulted in deficits of total fatty acid content, but did not affect the proportional distribution of individual fatty acids among phospholipids. By contrast, longer chain (22- and 24-carbon) fatty acids accounted for more than half the fatty acid content of myelin cerebroside and sulfatide from the 19-day-old control rat pups. In undernourished rats of that age, proportions of lignocerate (24:0) and nervonate (24:1) in cerebroside and sulfatide were 40-50% lower than those in control rats. This, together with higher proportions of 16:0, 18:0 and 18:1 and a higher ratio of C16-C20 to C22-C24 in undernourished than in control rats, suggests an impairment in fatty acid chain elongation. Ten days of nutritional rehabilitation failed to restore the fatty acid imbalances; however, after an additional 5 days of ad libitum feeding, the experimental and control values were similar. The undernutrition results in hypomyelination, which is characterized by a proportional decrease in lignoceric and nervonic acids of sphingolipids.

Selective persistent reduction in choline acetyltransferase activity in basal forebrain of the rat after thyroid deficiency during early life

The effect of thyroid deficiency on the activity of choline acetyltransferase (ChAT; the marker for cholinergic neurons) was studied in different parts of the rat brain at ages 5, 10, 15 and 25 days, and at day 130 following 102 days of rehabilitation. During normal development, the activity of ChAT increased in the cerebral cortex, hippocampus and basal forebrain, and decreased in the cerebellum. Neonatal thyroid deficiency resulted in a marked retardation of the developmental patterns of the enzyme activity. In the hippocampus the effect diminished with age even during the period of thyroid hormone deprivation, while in the cerebral cortex and cerebellum the enzyme activity was restored to normal only after rehabilitation. In contrast, ChAT activity in the basal forebrain remained persistently reduced in comparison with controls. The results indicate that neonatal thyroid deficiency causes selective irreversible biological damage to subcortical cholinergic neurons.

Effect of thyroid deficiency on the regional development of glutaminase, a glutamatergic neuron marker, in the rat brain

The effect of thyroid deficiency on the activity of phosphate-activated glutaminase (the marker for glutamatergic neurons) was studied in different parts of the rat brain at ages 5,10, 15 and 25 days and at day 130 following 102 days of rehabilitation. The brain regions investigated were the cerebral cortex, basal forebrain, hippocampus and cerebellum. During normal development, the activity of glutaminase increased relatively earlier in the cerebral cortex and hippocampus than in the cerebellum, while the absolute value reached a much higher level in the hippocampus than in other brain regions. In the basal forebrain, the developmental pattern of glutaminase was bimodal and the rise in enzyme activity after 15 days coincided with the decrease in the cerebral cortex. These regional developmental changes in glutaminase activity correlated well with known information on the formation of glutamatergic cells and pathways in the brain. Neonatal thyroid deficiency had little effect on the developmental patterns of enzyme activity, the exception being a transient decrease in 10-day-old hypothyroid hippocampus. The present results, together with previous findings, indicate that the effect of thyroid hormone on neural maturation is cell-type specific and the glutamatergic neurons are not the main targets of thyroid hormone action.

Discriminant function of complement C3, serum albumin and anthropometric measurements in identifying malnutrition

A prospective study was conducted on 32 malnourished and 12 healthy pre-school children to study the role of certain variables, viz., supine length, weight-for-supine length, complement C3, weight-for-head circumference, serum albumin, weight and mid-arm circumference, in detecting the presence of malnutrition and to grade the severity of malnutrition. Out of 32 malnourished children 14 cases were re-investigated after 15 days of nutritional rehabilitation to find out the significant discriminator(s) of pre and post-treatment condition. Step-down discriminant analysis showed that supine length, weight-for-supine length and complement C3 were efficient discriminators in detecting cases of malnutrition. To transform the variables, viz., supine length, weight-for-supine length and complement C3 (each expressed as a percentage of standard-for-age) into score form, respective simplified weights, for multiplication, were found to be 0.9, 0.4 and 0.1. A dividing score (Z) of 123.1, with a bordering range () of 119.6 to 126.7 for 90% probability limits, separated malnourished from healthy children. For classifying children with respect to severity of malnutrition, weight-for-supine length and serum albumin concentration were found to be significant discriminators. Malnourished children with oedema (N=11) had higher weight-for-supine length ratio and lower serum albumin concentration as compared to non-oedematous malnourished children (N=21). While oedematous and non-oedematous malnourished children were almost equally stunted, higher weight for supine length ratio was attributed to accumulation of oedema fluid, in the former group. A subsample of 14 malnourished children who had received a 15-day nutritional therapy could be differentiated from their earlier condition (before treatment) by a significant rise in complement C3 and serum albumin levels.

Extinguishing conditioned responses during opiate dependence treatment turning laboratory findings into clinical procedures

Former opiate addicts (even those who have remained drug-free for several months) often report symptoms of opiate withdrawal (eg. nausea, gooseflesh, etc.) and/or intense drug craving when exposed to stimuli previously associated with the act of drug injection. This phenomenon of learned or “conditioned” withdrawal/craving is widely reported and is potentially important in explaining relapse to drug use. However, no effective, clinically applicable intervention had been available to “extinguish” these conditioned phenomena. An ongoing project to develop such an intervention has revealed: 1. 1. Conditioned withdrawal and craving are pervasive among both methadone maintained patients (even though actual physical withdrawal is blocked) and drug-free patients even after 30 days of inpatient Therapeutic Community rehabilitation. 2. 2. Conditioned withdrawal and craving can be effectively extinguished in an intensive, three-week, inpatient procedure. 3. 3. Emotional states such an anger, depression and anxiety can elicit and exacerbate conditioned withdrawal and craving. They may also act as an integral part of a conditioned stimulus complex. The authors discuss the problems associated with turning a laboratory-based procedure into a clinical intervention. Encouraging preliminary results from an integrated treatment “package” are presented.