As America continues to face the opioid epidemic, numerous people have made great strides in receiving formal treatment for their opioid use disorder (OUD). This research seeks to examine the effects providing OMT along with traditional OUD pharmacological methods in providing results for patients. By utilizing prior research on OMT techniques, we were able to uncover how effective OMT can be in reducing the time and discomfort associated with seeking opioid recovery. OMT in combination with traditional pharmacology was associated with reduction of somatic pain, higher success with MAT, as well as lowered costs. This research also highlights the importance of OMT in the era of COVID social distancing, as well as special considerations to be taken for those with trauma histories associated with their disorder. We argue the benefit of OMT in combination with pharmacological methods at reducing the overall burden of prior opioid use disorders

Abend, David

Shmuts, Rachel

Soled, Heather

Street, Kyle

English

Rowan University

Rowan University Rowan Digital Works Stratford Campus Research Day 27th Annual Research Day May 4th, 12:00 AM The Virtues of Osteopathic Manipulative Treatments in Patients with Opioid Use Disorder Rachel Shmuts Rowan University Heather Soled Rowan University Kyle Street Rowan University David Abend Rowan University Follow this and additional works at: https://rdw.rowan.edu/stratford_research_day  Part of the Alternative and Complementary Medicine Commons, Health and Medical Administration Commons, Osteopathic Medicine and Osteopathy Commons, Pathological Conditions, Signs and Symptoms Commons, Substance Abuse and Addiction Commons, and the Therapeutics Commons Let us know how access to this document benefits you - share your thoughts on our feedback form. Shmuts, Rachel; Soled, Heather; Street, Kyle; and Abend, David, "The Virtues of Osteopathic Manipulative Treatments in Patients with Opioid Use Disorder" (2023). Stratford Campus Research Day. 78. https://rdw.rowan.edu/stratford_research_day/2023/may4/78 This Poster is brought to you for free and open access by the Conferences, Events, and Symposia at Rowan Digital Works. It has been accepted for inclusion in Stratford Campus Research Day by an authorized administrator of Rowan Digital Works. The Virtues of Osteopathic Manipulative Treatments in Patients with Opioid Use DisorderRachel Shmuts, D.O., Heather Soled, OMS III, Kyle Street, D.O., and David Abend, D.O. Rowan-Virtua School of Osteopathic Medicineo The opioid epidemic continues to rise in the United Stateso Numerous treatments are available for opioid use disorder (OUD) o Multiple factors play a role in the development of a substance abuse disorder, considering them all is essential for guiding treatmento Osteopathic manipulative treatments (OMT) can be widely used in patients with OUD o OMT can be found to decrease the time and discomfort associated with OUD recoveryo OMT in combination with traditional pharmacology was associated with reduction of somatic pain, higher success with MAT, as well as lowered costs. o Special considerations for patients with trauma history associated with OUD are established o Importance of hands on patient interaction in the COVID-19 era o OMT in conjunction with pharmacological methods reduces the overall burden of OUDBackgroundPatients with substance use disorders often experience extreme withdrawal symptoms, including vomiting, fatigue, sweats, insomnia, and delirium. We propose that there are multiple OMT techniques that can target these specific dysfunctions: 1. Stomach pain, discomfort, and tenderness can be mitigated by use of Chapman's points.2. Lymphatic technique can be utilized for withdrawal symptoms of headache and congestion. 3. The physician can practice techniques of OCMM to help lessen the withdrawal side effects of insomnia and delirium.  OMT TechniquesOMT combined with pharmacological treatment, as compared to pharmacological alone, on the OUD patient can lead to better outcomes (e.g., a decreased MAT maintenance dose, lower rate of relapse, lower admissions rates to rehabilitation programs, and improved compliance with MAT). OMT targets the same pathways that the abused drug might, improves circulatory effects, and is widely recognized and accepted both in literature and by the insurance industry. OMT offers a cost-effective method that, when combined with pharmacological drugs, can provide the patient with maximal care. Our research team hopes to start a deeper investigation of many of our claims. By conducting more in depth studies of the effectiveness of OMT in OUD patients, we hope to raise continued awareness of the importance of implementing OMT in daily practice with OUD patients.ConclusionThese tenets can be applied in the context of OUD, a complex, multi-system disorder in which there are changes in the structure and function of the brain and other organs due to the chronic use, misuse, and abuse of opioids. One of the primary goals of osteopathic manipulation is to promote the body’s natural inclination toward homeostasis. In patients with OUD with disruption in homeostatic mechanisms, both physiologically and somatically, OMT can be used to restore the proper balance and enhance recovery.When using opioid medications, patients with OUD have an exaggerated reward response via dopaminergic pathways which can reinforce the repeated use and lead to the maladaptive behaviors. We theorize that a similar reward response can be elicited while receiving OMT. By stimulating dopaminergic pathways through the viscerosomatics of OMT, we predict general improvements in each patient’s health, including his/her overall physical and mental well-being.IntroductionCOVID ConsiderationsMany patients who suffer with substance use disorders also have (i) comorbid trauma histories and (ii) special consideration needs which have to be heeded when touching patients who have experienced any kind of physical or sexual trauma in their past. It is important to initiate trauma evaluation compassionately by gently asking about the following parameters: 1. Screening for exposure to traumatic event 2. Potential triggers for trauma 3. Symptoms associated with trauma (fear, horror, etc.) 4. Detailed understanding of exposure5. Full psychiatric evaluation screening for PTSD, suicidal ideation, and risk assessmentBy taking the time to assess patient boundaries and comfort, providers are able to better foster patient-physician connections that can help aid in the path to healing. Suggestions include the following:1. Communication. Using layman's terms, make the nature of the technique known and what area of the body is being worked on.2. Model. Use models and safe skin areas to demonstrate pressure, temperature, and any assistive devices associated with the technique utilization.3. Boundaries. Set clear expectations with your patient prior to any touching about areas they would want you to avoid. 4. Witness. For the duration of the treatment, have the same gender health care worker as the patient present in the room. 5. Time Option. Offer multiple shorter sessions for the patient to help ease them into the process and new stimulation. 6. Soft techniques. Any soft tissue should be handled with pressure in accord with patient’s comfort level. 7. Discussion. Open discussions with the patient to assess the mental and physical feelings that emerge from treatment. 8. Interpersonal. Referring patients with trauma for both medical management as well as EMDR, CBT, and other types of psychotherapy. Trauma Considerations1. The reduction of subjective painAutonomic-centered OMT treatments normalize the sympathetic or parasympathetic response. Some possible OMT treatments that have been suggested for conditions like anxiety or elevated heart rate include, but are not limited to, the following:o Occipitoatlantal (OA) release, rib raising, Cervical/thoracic/lumbar soft tissue (ST), or myofascial release (MFR).By implementing techniques that negate these sympathetic symptoms, patients will be less subjected to withdrawal symptoms. The perception of touch can elicit positive physical and emotional responses in patients with OUD, as mediated by a variety of neurotransmitters. Beta endorphins are known to be associated with positive affect, mood, and sense of well-being. By stimulating these same pathways, the patient may feel a familiar sense of comfort and release. 2. Fewer titration trial doses Many OUD patients seek and receive medication-assisted treatment (MAT), including methadone and buprenorphine, to achieve remission and recovery. In one study, it was found that patients on MAT were able to remain addiction-free 60% of the time while on the medication as compared to those OUD patients on placebos. Despite the effectiveness of MAT, finding the correct dosage for patients can be a time- consuming, elongated process, which proves painful and uncomfortable for patients, as withdrawal symptoms heighten. Lymphatic techniques are able to help clear the body of toxins and inflammation, reducing the risks of infection. When lymphatic techniques are used in conjunction with MAT, OUD patients experiencing withdrawal can have less risk of infection and toxins harboring in their body. Lymphatic techniques can reduce the time and dosage of MAT necessary to obtain the most beneficial outcomes for OUD patients.3. Reduced CostOMT is an option for all patients, regardless of socioeconomic status, that can be performed in the office with no equipment and is often covered by insurance. , OMT is widely accepted in literature as a legitimate treatment option and represents a cost-friendly alternative to have pleasure pathways responses. OMT adds to the toolkit of primary care physicians and offers a noninvasive, low cost, and low risk option for patients. One study conducted demonstrated that osteopathic manipulation along with traditional pharmaceuticals is one of the top ten most common complementary health approaches among adults. ResultsThe body is a unitThe body is capable of self regulationThe importance of the body as a wholeStructure and function are reciprocally relatedo Social distancing has led to abrupt cessation of many people’s joyful outlets for stress and copingo Multiple medical practices began enforcing telehealth visits o The peak pandemic time showcased increased substance useo Between 2020-2022, it was found over 13% more people abused alcohol and/or opioidso OMT is preformed in person and requires repeated treatmentso Repeated visits increase patient physician trust alliance o Visits allow patients the chance to leave the house and have human interaction o Propper PPE can be used while preforming OMTtechniques (masks, gloves, gowns, etc)o Increased trust allows for patients to more likely take their physician's advice o Trusting physicians allow for more frequent and longer one-on-one contact The tenants of Osteopathic medicineThoracic Lymphatic PumpCompression of the Fourth Ventricle  Pedal PumpRib Raising

The Virtues of Osteopathic Manipulative Treatments in Patients with Opioid Use Disorder

https://rdw.rowan.edu/cgi/viewcontent.cgi?article=1359&context=stratford_research_day

The Virtues of Osteopathic Manipulative Treatments in Patients with Opioid Use Disorder

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