The opioid epidemic is a national crisis. Every day, an estimated 130 people die in the United States from an opiate related overdose. Many of these deaths can be attributed to an initial or current misuse of prescription opioids, often prescribed to treat acute and chronic pain. The US Centers for Disease Control and Prevention (CDC) estimates that the annual economic burden of prescription opioid misuse in the United States alone is $78.5 billion, which includes the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. About 80 percent of people who use heroin have misused a prescription opiate first. These types of staggering statistics go on, but the point is that the opioid epidemic is a real problem requiring realistic, effective, and timely solutions.

A Multi-faceted Approach
Many different areas need improvement when considering potential solutions to the opioid crisis, and it will likely be advancement in all of them that results in a real progress. Those who already suffer from an opioid misuse disorder need improved access to evidence-based treatment. It is imperative to advance research in overdose therapy, medication-assisted therapy, and opiate abuse risk reduction. Most relevant to the field of focused ultrasound is the establishment and promotion of alternatives to opiate-based medications for the treatment of pain. Another area that has the potential to use focused ultrasound is in the identification and development of new therapies to aid in abstinence from opiates.

New data suggest that efforts in some of the areas listed above are already having an impact; in 2018, the number of fatal overdoses in the US declined for the first time in three decades.

Focused Ultrasound’s Impact on Painopioid crisis graphic 16x9
At present, focused ultrasound is being used as an alternative or complement to medication therapy for pain secondary to bone metastases and osteoid osteoma, a condition that produces painful bony tumors primarily in children and young adults. There are numerous other chronic pain conditions for which focused ultrasound is being investigated as a potential treatment option.

Chronic back pain is one of the most common pain conditions for which people seek medical treatment. Focused ultrasound is now being investigated as a therapy to treat pain caused by lumbar facet arthritis, which accounts for up to 40 percent of chronic back pain. For this treatment, the ultrasound beam is aimed at a nerve that transmits pain signals from the inflamed joint space with the goal of thermally destructing the nerve fibers, therefore eliminating the pain signal to the brain. The use of focused ultrasound for this indication is approved in Europe and Canada, and another study is under way in the US. Focused ultrasound to treat facet arthritis has great potential to reduce pain, thus reducing pain medication consumption.

Chronic pain secondary to knee arthritis is also being treated with focused ultrasound. A clinical trial in Japan using focused ultrasound to thermally ablate one of the nerves that supplies sensory innervation to the knee joint was recently completed, and the results should be published soon. Given the high prevalence of chronic back and knee pain, the potential impact that focused ultrasound could have on the treatment of these conditions and the reduction in countrywide opioid consumption is compelling.

There are additional clinical trials involving focused ultrasound for the treatment of chronic neuropathic pain, amputation neuroma pain, facial pain, and pancreatic cancer pain – all of which are being funded by the Foundation.

Novel Research to Tackle Addiction
In 2018, The National Institutes of Health (NIH) launched it’s Helping to End Addiction Long-term (HEAL) initiative – an aggressive, trans-agency effort to speed scientific solutions to the opioid public health crisis. Hundreds of projects are being funded nationwide, including five projects using focused ultrasound. Most notably, a study at the University of Virginia is examining the use of focused ultrasound to thermally ablate a region in the brain called the mesencephalon in patients with head and neck cancer pain. The other focused ultrasound projects being funded by this initiative are preclinical laboratory studies examining the potential of using focused ultrasound for chronic low back pain (using neuromodulation rather than thermal ablation), sickle cell pain, and neuromodulation of pain circuits within the brain. For further information, see our November newsletter article on this topic.

Finally, focused ultrasound is being investigated as a potential opiate addiction treatment at the West Virginia University Rockefeller Neuroscience Institute . Neurosurgeon Ali Rezai, MD, and his team are exploring the use of applying low intensity MR-guided focused ultrasound to the nucleus accumbens – a key area of the brain involved in addiction – using neuromodulation to treat opioid use disorder.

Foundation Seeking Project Proposals for Funding
Although many indications are in the early stages, focused ultrasound exhibits great potential to reduce the prescription and consumption of opiate-based pain medications, thus creating an impact on the opioid epidemic. The Foundation is enthusiastically calling for research abstracts which may contribute to this area.

Additional Resources:
Focused Ultrasound and Opioid Addiction
Focus Feature: Focused Ultrasound and Chronic Pain
Focused Ultrasound and Addiction
Five Sites Awarded Funding for Focused Ultrasound Research for Pain Management

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Lauren Powlovich, MD, is the Director of Special Projects at the Focused Ultrasound Foundation.

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