Opioids are natural, semi-synthetic, or synthetic chemicals that interact with receptors in the body to reduce the perception of pain. (Opioids can be natural or created in a laboratory; opiates are extracted from the poppy plant.)
Opioid use disorder (OUD) is a severe substance use disorder. People may be dependent on opioids (drugs like codeine, tramadol, tapentadol, and morphine) that are often prescribed for pain relief, or on street opioids (heroin, brown sugar, etc.). As the body becomes accustomed to the opioids, it can cause severe withdrawal symptoms, including watery eyes and nose, severe body aches, flu-like symptoms, insomnia, anxiety, and irritability. Chronic use can cause cognitive decline, sexual dysfunction, severe impairment in social and occupational functioning, and increased financial burden.
In order to find alternatives to opioids for pain control, a study to develop a yoga module to reduce opioid use was conducted by Dr Hemant Bhargav from the Centre for Yoga Integration at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore.
Alternative pain control
Yoga has been shown to increase gamma aminobutyric acid (GABA) levels and oxytocin in the brain, which may contribute to managing opioid withdrawal symptoms and reducing relapse. Yoga has also been shown to increase frontal lobe activation, reducing impulsivity and improving self-control, helping to promote positive behavioral change.
“Initial clinical case studies with nine months follow-up have shown that the module is suitable for bringing relief to patients suffering from opioid addiction,” said a press release from the Department of Science and Technology, Government of India.
They then conducted a randomized controlled trial in which 60 subjects were divided into two groups: one group did yoga in addition to standard care, and the other group did exercise in addition to standard care. After 12 weeks of intervention, they observed that subjects in the yoga group were 2.68 times more likely to have a negative urine test for opioids than those in the exercise group.
The study suggests that yoga may be a useful adjunct tool to help alleviate withdrawal symptoms and reduce the severity of drug use in people with opioid addiction. Additionally, the yoga group experienced significantly less pain, cravings, anxiety, and depression compared to the exercise group, as well as significantly improved quality of life and sleep.
The results also showed that when OUD patients viewed opioid-related cues, bilateral brain regions were significantly activated. These regions are involved in salience attribution (anterior cingulate cortex and insular cortex) and the brain arousal/stress system in the extended amygdala-hippocampal region. This suggests a potential mechanism by which yoga may reduce craving and improve abstinence. Furthermore, the study suggested that yoga may reduce rumination and allow people to be more relaxed, thereby improving the pathophysiology of the disease.
“Yoga and meditation were chosen by 34 percent of Indians suffering from chronic pain, especially women,” wrote the paper written by Bhargav and team. “Yoga may increase pain threshold and provide a natural ‘high’ by inducing deep relaxation and peace of mind,” the paper said.
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