The application of aerocryotherapy in the course of addiction treatment.

Vasylenko V. I., Sarzhevsky S. N., Shevchenko O. V., Lazebny D. N.

Rehabilitation center for drug addiction treatment, Zaporozhye

 

The possibility of treatment with cold has been used since ancient times. Tempering system by German scientist P. Kneipp is widely known in modern medicine. The analog to this system exists in our country (by Ivanov P.K.). In the 70’s of the last century Japanese scientist Dr. Yamauchi developed a new method of treatment using ultralow temperatures.

Since then his numerous followers continue to introduce this technique called aerocryotherapy (ACT) into medical practice. It is a single-step cooling of the entire surface of the human body in a gaseous medium with ultra low temperature (up to - 180°C).

Effectiveness of therapeutic application of cold is caused by physiological mechanisms. Single exposure determines the development of adaptation to the cold stimulus. This device can be seen in a variety of physiological systems, and the lower is the temperature of exposure the better is the effect. Tempering with cold causes an aftereffect, that is observed after the course of treatment and is manifested in the complex biochemical changes during the next few months.

It is noted that the protective physiological response to dosed general cooling is useful for patients with rheumatic diseases; it reduces the pain and relieves muscle spasms. Response is also seen in vegetative-vascular changes, which are related to the activation of the adrenal glands. According to R. Fricke (1989) therapeutic effect of general ACT in motor apparatus diseases treatment is caused due to stimulation of anterior pituitary function. Recently some researchers explain the effect of ACT by participation of neuropeptide system and the formation of endogenous morphine-like substances - opioids, through which the cooling effect is realized.

Such mechanisms are interesting for application of ACT in drug addiction treatment, as for a more rapid and effective treatment of withdrawal syndrome and for a course of treatment of drug addiction in general.

Pain syndrome is one of the most painful manifestations of opiate withdrawal. This is why the ability to control muscle tone, relieve muscle spasm, anesthesia and analgesia are particularly desirable effects. However, there was no experience of applying ACT to patients using psychoactive substances found. Basically indications for ACT treatment were rheumatology, vertebroneurology, cosmetology, cardiology, traumatology, sports medicine. At the same time it is clearly emphasized that the main therapeutic effect is associated with general anesthesia that owes its origin to cold anesthesia of receptors, anti-inflammatory, intensive vasodilator and muscle relaxant effects.

Therapeutic effects of ACT implemented in practice of addiction treatment are determined by positive influence of cold itself on liver cells. Increased blood flow to the internal organs and the transition from cold to heat is the mechanism necessary for the training of circulatory system. Blood carries the excitatory neurotransmitters and oxygen, enhances greatly the antioxidant properties of parenchymatous organs, particularly the liver, and improves metabolic processes. Thus, ACT significantly enhances microcirculation and improves trophic processes in organs and tissues, affects the rheological properties of blood, has a strong immunomodulatory effect, promotes sharp activation of detoxification systems of the body, where the main host of all process is the liver.

Knowing that the overwhelming number of patients that used drugs suffer from chronic hepatitis and cirrhosis, similar effects facilitate medical comorbidity and form a fertile ground for further psychotherapeutic influence.

In Medical Center of Dr. Vasylenko 236 patients with addictions were treated by methods of ACT in 2007 and 2008.  We used cryosystem "Cryosauna SPACE-CABIN", (CRYOMED Ltd., Kherson) with possible temperature exposure of -130°C to -170°C and charged with liquid nitrogen.

The main indication for this procedure was the presence of substance dependence with or without withdrawal symptoms apart from the type of psychoactive substance. Contraindications for general ACT were: cardiovascular system disorders, hypertensive disease of the 2nd degree, cardiac insufficiency of the 2nd degree, heart rhythm abnormality, and specific cold intolerance. Doctors carefully explain the principle of extreme action of ACT to the patient before the procedure, so it would not be perceived as traditional tempering. It is important to clarify that the velocity of heat aversion from the surface of the body is so stressful, that it forces the body to react not only by thermoregulation system, but also by all adaptive mechanisms; short-termed uncomfortable sensation of coldness the patients overcome rapidly.

Sessions of ACT lasted 60-120 seconds; the course usually consisted of 10-20 sessions. Gradual increase of the procedures’ length (10-20 seconds daily) showed its effectiveness. With concomitant chronic hepatitis or cirrhosis in stages of compensation the number of ACT procedures was increased up to 25 procedures, and the mode increased to 180 seconds. In some cases, the ACT sessions began with the maximum - 120 seconds and subsequently were reduced to 50 seconds for the sake of tonic effect.

Procedures were appointed from the first day of admission to the center, and the greatest efficiency was seen in cases when the treatment coincided with the first days of withdrawal. Also the duration of usage of a psychoactive substance, its kind, age and sex of the patient, treatment willingness were important.

If the period of using opiates was not long it is allowed to start ACT sessions from the second or even third day of admission. It is the period of the withdrawal beginning. It is initially manifested in muscles pain of arms, legs, back, waist, and abdomen. This pain is rather distressing for patients and determines their overall condition. During this period all thoughts are focused on the drug, patients complain on pain in bowels, frequent intestine discharge and loss of sleep. Appointment of ACT in this period gives evident analgesic and relaxing effects, allowing patients to alleviate their condition. Considering that the center is mainly focused on non-medicine and non-traditional methods of treatment, such therapy makes it possible to reduce the prescription of painkillers and sedatives. Such effects require anchoring, especially knowing about the sequence of reduction of withdrawal symptoms: firstly dyspepsia stops, then the pain goes away and then the sleep comes to normal.

In cases with originally sedative effect, the procedure began with prolonged exposure modes: up to 120 seconds, and required the maximum cooling temperature. Patients themselves were pleased to note that after this procedure they slept for 3-4 hours, although before their sleep was short (1-3 hours). Apparently, in these cases the cold stimuli effects sum with the effect of limiting inhibition (by Pavlov. I.). It is curious that this effect was absent during first and short-termed procedures. In case of the use of homemade opium drugs the abstinence has some peculiarities. Its manifestations are growing like an avalanche, and their intensity is on top on the second day after the rejection of the drug. Pain syndrome appears simultaneously with sweating, chills, runny nose. Pain in muscles and joints is longer with an undulating rhythm of intensity: weaker in the afternoon and stronger in the evening. In this case ACT is necessary from the first day with the obligatory daily regime and maximum sustained temperature of minus 170°C.

After withdrawal treatment it is necessary to consider the following condition with all psychopathological disorders, sense of mental discomfort, asthenia and various depressions on the first place. The predominance of dysphoric depression with anxiety, apathy or malice is a hallmark of heroin addiction. During this period the tonic effect of ACT is necessary. Thus the patients note the emerged interest in the environment, the desire to go to the gym or for a walk, this state is often described as "spry". This effect anchors the desire of patients to continue the course. In our study, similar effect was noted at exposure to 50-60 seconds of cold and the total cooling temperature of minus 130°C. The effect of this procedure has arousal and immunomodulatory long lasting  effect (up to 6 months after its finishing).

Almost all patients reported improvement in their general well-being, increased efficiency, men talked about the positive impact on the reproductive system. By introduction of ACT into the process of complex treatment of withdrawal, its duration was reduced to 4-5 days, during this period the patients’ condition allowed them to receive treatment with minimum prescription of medicine (or without it at all). The majority of patients had comorbidities, such as phlebitis and various cutaneous manifestations as consequences of drug injection. In these cases, the homeostasis modulating effects of ACT were taken into account; the ultimate goal was to achieve remission of cutaneous manifestations, if this is not possible, then at least resistant cosmetic comfort. The intensification of the effect was conducted by using a combination of ACT and ultraviolet impact in the solarium.

Thus, depending on the expected effect, we used the following embodiments of ACT:

 

1. For evident anesthesia, intensive sedative and vasodilator effects it is necessary to conduct the first sessions with maximum duration (100-120 seconds) and the highest cooling ( -180°C). After 7-10 procedures the regime intensity must be gradually decreased;

 

2. For tonic, immunomodulatory and tempering effects minimum duration (50-60 seconds) and cooling to minus 130-150°C must be applied. Rehabilitation regime meant a slight increase to 20 - 25 sessions.

The total number of ACT procedures and the breaks between them are selected individually, according to prescription.

The study demonstrates the effectiveness of general aerocryotherapy as non-medicine method in the course of complex treatment of patients that use psychoactive substances, and determines its range of therapeutic possibilities. The total number of ACT procedures and the breaks between them are selected individually, according to prescription.