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New Technique Shows Promise as Adjunct In Chronic Pain Management

The Bio-Acoustical Utilization Device (BAUD), a biofeedback device, has shown promise in the management of patients with central sensitization.
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In our protocol, lower pitch frequencies are used for pain in the lower body and low back, whereas high pitch frequencies are used for upper body areas. The reasons why this works are not fully known, and come mostly from observation and patient reports. G. Frank Lawlis, MD, a medical psychologist and inventor of the BAUD settled on these frequencies after reviewing research about resonance frequencies of the human body, and fine-tuned the frequencies in his clinical practice. BAUD shares frequencies in common with most-used TENS frequencies from 0 up to 250 Hz.18

In the second step, the disruptor knob is slowly advanced, producing a binaural pulse that, again, directly affects the amygdala. When properly set (almost always in the 4-8 Hz theta range), the disruptor has the effect of weakening or reducing the target symptom. This is felt almost immediately as a marked reduction in the pain sensation. In this way, we use the brain as the monitor (and the patent’s sensations) to adjust the BAUD’s input. The unit is left on for 15 to 20 minutes, with the person focusing on the areas of pain to maintain the level necessary for acoustical neutralization.

BAUD is more than a momentary distraction, however, since brain imaging (EEG) shows positive neural changes both during the BAUD session and persisting long after (EEG, fMRI and LORETA). Patients also report enduring relief. We believe that disrupting the active pain circuit also interferes with its reconsolidation, thereby reducing even persistent chronic pain.

People with chronic pain and CS sensitization are excellent candidates for BAUD therapy, provided they are not overly sensitive to loud, noxious noises. People with auditory sensitivity are more prone to agitation and a worsening of their symptoms when this therapy is employed.

Case Studies

Case 1

A 58-year-old veteran presented with a 10-year history of constant thoraco lumbar pain and intermittent lower extremity paresthesias. His past medical history included a diagnosis of fibromyalgia, post-traumatic stress disorder, substance abuse, bilateral carpal tunnel syndrome, and left knee arthroscopic debridement of a medial meniscus tear.

His medication regimen included atenolol (Tenormin, others), hydrochlorothiazide (Microzide, others), fluoxetine (Prozac, others), amitriptyline, and simvastatin (Zocor, others). In addition, he had a home transcutaneous electrical nerve stimulator (TENS) unit and an Alpha Stim (Electro Medical Products, Mineral Wells, Tx) unit, which he used daily for anxiety. His physical evaluation is outlined in Table 1.

His initial treatment plan included iontophoresis with acetic acid for the anti-inflammatory effect, therapeutic ultrasound, thoracic-lumbar decompression, and a mobility exercise program. After 4 treatments, the patient was unchanged with respect to pain or function.

BAUD therapy was added to his treatment plan and after 4 more treatments he was able to stand for 2 hours, walk for 2 miles, cut wood with a chainsaw, and sleep through the night. His lumbar flexion returned to 90 degrees without pain, and extension was 25 degrees without pain. He also reported that he was able to sleep better and think more clearly.26 No further treatments have been required in over a year.

Case 2

A 47-year-old woman who was diagnosed with post-traumatic heterotrophic ossifications in both hips and lower legs and required bilateral axillary crutches for the previous 10 years, presented to our clinic. Because of her method of locomotion, she developed cervical pain that was greater on the right side (Verbal Pain Scale, [VPS], 7 out of 10), with trapezius, levator scapula, and rhomboid hypertonus. An MRI confirmed a herniated nucleus pulposus of C 5-6.

Her medical history was significant. She had difficulty turning her head, sleeping, and had 5 to 6 headaches a week. She had undergone trigger point injections and occipital nerve blocks with some pain relief (5 out of 10 VPS). She admitted to being hypersensitive to many medications as well as to bright lights.

Her current medication regimen included ibuprofen (Advil, Motrin, others) 600 mg PRN, hydrocodone/acetaminophen (Norco, Lortab, others) 5/325 mg QID, and monthly pamidronate infusions. She reported being allergic to gabapentin (Neurontin, Gralise, others) and ondansetron (Zofran, Zuplenz, others). Her physical evaluation results are outlined in Table 1.

She had been seen in physical therapy previously, receiving electrical stimulation, therapeutic ultrasound, soft-tissue massage, laser treatment, and mobility exercises, with little symptomatic change after 5 treatments. BAUD therapy was added to her treatment plan, and she noticed a reduction of headaches and cervical hypertonus with easier cervical mobility after 4 more treatments (VPS, 3 out of 10). Her range of motion improved globally by between 25% and 30% of initial measurements. She required additional treatments 6 months later due to a return of symptoms.

Case 3

The third clinic case is a 61-year-old woman who had been in a severe head-on motor vehicle accident when she was 17 years old. She sustained a fractured left femur and multiple fractures of the right ankle, necessitating a triple arthrodesis. She had had chronic back, right foot, and left knee pain, which had been unrelieved by oral analgesics and over-the-counter ibuprofen, since her accident 44 years previously.

She had undergone physical therapy after her accident, but had no formal treatment since then except for exercises after an arthroscopic left knee debridement of a loose body 10 years previously. She admitted to being sensitive to medications, bright lights, and loud noises since her accident.

BAUD therapy was attempted, but the patient could not tolerate the noxious sound, even at the lowest setting. She reported a feeling of agitation afterwards that lasted for 2 days. Her treatment plan was changed to a hands-on approach using the Associative Awareness Technique (AAT),27 and the patient reported an immediate improvement in her symptoms. Theoretically, AAT is designed to change conditioned negative association by creating new positive sensory and cognitive awareness.

The therapist uses 5 types of safe sensory input of scratching, tapping, vibration, deep pressure, and light touch to the patient’s extremities. These sensations are designed to affect the sensory nerve endings and mechanoreceptors in the skin, which are the primary barrier between the environment and the nervous system. During AAT treatment, the patient is instructed to avoid focusing on the areas of pain in order to change the current negative associations of helplessness and stress.

Summary

The addition of BAUD therapy can be a useful addition to the overall treatment regimen of people who have experienced chronic pain caused by sensitization of the neural circuits of the amygdala. The addition of BAUD therapy can help improve function, as illustrated in case 1 and case 2, and decrease pain, as shown in case 2. Theoretically, this treatment would be the non-pharmaceutical treatment of choice in people who are hypersensitive to touch, such as autistic patients with known tactile sensitivities.

Last updated on: February 9, 2016
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Chronic Back and Neck Pain in America 2015 Survey Results
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