- [Announcer] Your fantastic mind brought to you in part by Sarah and Jim Kennedy.

(energetic music) (energetic music continues) - Welcome to "Your Fantastic Mind."

I'm Jaye Watson.

Our episode tonight tackles issues that impact millions and millions of Americans.

We are exploring non-invasive ways to treat chronic pain, and we take you inside a study that is using vagus nerve stimulation to treat people with opioid use disorder.

But first up tonight, back pain, one of the most common medical problems in the country.

Those who live with it know it can affect every part of life, from work to sleep to emotional wellbeing to every part of daily functioning.

People with back pain even report higher levels of depression.

Sometimes surgery is necessary, and there is a new innovative approach that is a game-changer in the field.

- [Bailiff] All rise.

State Court of Cobb County is now in session.

The Honorable Judge Marsha Lake is presiding.

- Good morning.

- Marsha Lake has been a state court judge in Cobb County for a dozen years.

- Most days I'm in court, it's a heavy court date.

I see over 100 individuals that come into court.

Have you gotten any return notices from this defendant?

- [Jaye] So when- - [Marsha] Out of the blue.

- [Jaye] She had pain in her lower right hip, this lifelong athlete saw a doctor who diagnosed her with muscle spasms.

- I went from walking, having a very active life, to not walking.

(dog panting) - [Jaye] Lake was sent to physical therapy and says she got worse.

That's because it wasn't a muscle spasm.

- A disk in L4, L5 had ruptured.

- [Jaye] A herniated disk happens when one of the soft cushion-like disks between the bones of your spine gets damaged.

Disks are sometimes compared to jelly donuts, with a soft gel-like center.

If the outer layer cracks or weakens, which can happen with injury or just aging, the gel inside can push out.

It herniates.

This bulging disk can press on nearby nerves, causing pain and weakness.

- I'm 77 years old.

It's just something that developed.

I will say that it just grew more uncomfortable to walk.

The big fish, which we call big boys, are- - [Jaye] Retiree Larry Garland and his wife Connie love to travel.

- [Larry] Big boy.

- [Jaye] But thoughts of trips faded as his ability to walk any distance proved impossible because of compressed nerves in his lower back.

- My back would feel like I was carrying a brick or something on the back of it.

It was just uncomfortable.

Well, it just continued to get worse and worse until I had to use this cane to hobble around and/or a walker in the house.

Connie, you wanna give me that cane?

It's just debilitating.

When you lose your mobility, you really just lose a big part of your life.

I just sat down and says, "I gotta get something done.

I gotta have some relief," you know?

- [Jaye] What Judge Lake and Larry Garland had in common was that their back issues dramatically impacted their quality of life.

They have a lot of company.

Roughly 16 million people in the US experience back pain they say gets in the way of daily life.

According to the World Health Organization, back pain is the leading cause of disability worldwide.

- I schedule my calendar a year in advance.

- [Jaye] Judge Lake never missed work, but she was often in a wheelchair outside of court.

- No one really understands when you can't walk because of the pain.

- So it's gonna involve one small incision in the center of your back.

- I'll be out at that point in time, so I won't hear, right?

- Yeah, yeah.

So what's gonna happen... - [Jaye] Both were candidates for minimally invasive endoscopic spine surgery.

- So the most common candidates, I will tell you, are patients that have a disk herniation, people that have leg pain, for instance, people that have pain down the buttocks, the thighs, so, typical like sciatica, for instance.

That's in the low spine.

In the mid back, if you have a disk herniation in your mid back, sometimes you're a candidate for that.

If you have a pinched nerve in your neck, sometimes you're a candidate for it.

So you can actually do endoscopic spine surgery in the neck, mid back, or low back.

- Yep, so this is the endoscope.

This here is technology that's evolved over the last, you know, 50 years.

- [Jaye] An endoscope is a scope that goes inside your body.

In the case of spine surgery, advances in technology have equipped it to do ultra minimally invasive endoscopic spine surgery.

- It has a 4K camera.

And so at the very tip of it, you have the camera.

You have the irrigation.

And then there's a working port.

And then there's also the light source.

So you have all of those tools in this very thin, slim device.

Through this, we can actually place instruments.

- [Dan] And we put that camera in, and that camera has one port that is flushing water.

So we're actually operating underneath water.

Well, your angle makes it wider, safer, right?

- [Jaye] Emory neurosurgeons Dan Refai and Matthew Gary- - [Matthew] So there's the traversing nerve root.

- [Jaye] Traveled to Germany to learn this new approach and to master its technical nuance.

- [Surgeon] Here comes the spinal process.

- [Jaye] It's popular in Europe and Asia and is gaining traction in the US but is not yet widely available.

- We've talked to a lot of surgeons.

We watched a bunch of videos, right?

Then we operated on little models like plastic models, right?

And we did all this stuff to get to a point where we're like, "Okay, I feel comfortable enough that I'm gonna do this on a patient," right.

That that's how medicine works.

- [Matthew] Here's where the stenosis is, at L4, 5.

Pretty severe pressure on the nerves here.

- [Jaye] In order to understand just how different ultra minimally invasive endoscopic surgery is- - We're making a really small incision.

- [Jaye] Dr. Gary describes how he would've done Larry Garland's surgery three years ago.

- What I would've done is something we call an open laminectomy, where I make an incision in the lower back.

It's usually about, I'd say two inches, basically separate the muscle off of the spine.

And then we'll start removing what really the whole goal of the surgery is, is the ligamentum flavum.

So we've removed a lot of structures that we don't necessarily need to remove to get the pressure off, but you have to for a bigger open surgery.

All right, I'm taking care of you.

- [Jaye] Instead, on Garland's surgery day, the incision is closer to the size of an eraser on a number 2 pencil.

- Essentially it's through a a seven-millimeter incision.

Kind of like that.

We dilate through the muscles, so there's very little injury to the muscles on the way down.

We're targeting and attacking the area that's causing the pressure on the nerves.

- [Jaye] Ultra minimally invasive endoscopic surgery minimizes disruption and trauma to muscles and ligaments and tissue around the spine, which is inevitable with open spine surgery.

There is less postoperative pain, less need for narcotics, and a speedier recovery.

This is what this surgery can look like.

- Yeah, amen.

(laughs) - [Jaye] Larry Garland walking unassisted to his car at lunchtime on the day of surgery.

There is no hospital stay, no months of recovery.

- [Worker] You having any pain today?

- No.

- All right.

- [Jaye] And six weeks later- - And a lot of this is is lifestyle changes too.

- [Jaye] At his follow-up visit, there is this.

- If you had to put a percentage on it, kind of comparing where you were before to where you are today.

- 95.

- [Matthew] 95, okay, fantastic.

(Dan knocking) - Hi, Judge Lake.

How are you doing?

- [Jaye] Judge Lake is back for a follow-up visit with Dr. Refai.

- I'm ecstatic for you.

And that nerve was pinched, and that's what's caused you all that leg pain.

- [Jaye] Judge Lake is back to exercising and doesn't miss a day of court.

As far as her recovery, she had open back surgery for another issue years ago and said it took six months to recover.

This time?

- I was home in my bed at 12:30 PM that day.

I don't have any lingering pain.

It's like it never happened.

(instrument hissing) - [Jaye] Doctors Refai and Gary trained neurosurgeon Juanmarco Gutierrez in this approach when he was a resident and fellow at Emory.

- There's nothing better.

There's nothing less disruptive, and there's nothing that could provide better relief of the symptoms in a very targeted way for the patient.

It was mind-blowing to see somebody, you know, have their spine operated on and go home that same day with minimal pain medication and calling them three days after and knowing that their symptoms have significantly improved, and their quality of life has, you know, improved immensely since they have the surgery.

- [Surgeon] You're starting to see some yellow ligament there.

You see that?

- [Jaye] While more surgeons in residence across the country are being trained, learning ultra minimally invasive endoscopic spine surgery presents a steep learning curve.

Refai and Gary are honest about the challenge in learning it.

- Well, when you start learning a new technique, those old apprehensive feelings come back again.

- This is like a super small incision through a camera.

You're 12 centimeters away.

You're looking on a TV screen.

You're not looking at the wound.

- If you've been out for 20 years and in practice for 20, 30 years, that takes a lot to go back and learn a whole new technique.

- [Surgeon] All this overgrown- - [Jaye] the next phase of minimally invasive endoscopic surgery, more complex spinal surgeries.

- How do we take endoscopic spine surgery from what we're doing, which is primarily bone removal, disk removal, and how do we then incorporate it into the mainstay of surgery?

So that's the next major phase.

I think that's gonna happen probably not even in 10 years, probably in the next three to five years.

- Now to a study that is taking a different approach to helping people who want to stop using opioids.

The opioid epidemic continues, with 87,000 drug overdose deaths in the past year.

This study is using a nerve within us to help people in those first days and weeks after they stop using.

- [Practitioner] All right, you're gonna feel nice little coolness going in your IV, okay?

(Stephen exhales) - Sunday night.

- [Jaye] 69-year-old Stephen Brannan recalls the last time he had an opioid four days ago.

- When I get really hurting really bad, I abuse it, whatever I can get my hands on.

- [Jaye] Brannan is candid about his use of drugs off and on since he was 26 years old.

Periods of recovery led to relapses.

- Plus I'm ashamed myself 'cause for 13 years I've worked with people with mental health and substance abuse issues when I was clean.

- And three, two, one, tap.

- [Jaye] And that's why Brannan is in Emory University Hospital in Atlanta as part of a clinical trial that is taking a new approach to help deal with withdrawal and cravings.

He had his last opioid before midnight on Sunday and checked into the hospital Monday morning at 6:00 AM.

- Hello.

- How you doing, Dr. Bremner?

- Good.

How are you?

(laughs) - [Jaye] Psychiatrist Doug Bremner is the director of the Emory Clinical Neuroscience Research Unit.

Dr. Bremner has done extensive research on PTSD.

- I've been doing brain imaging studies in post-traumatic stress disorder for many years and also looking at mechanisms of how stress affects cardiovascular disease.

- [Jaye] Bremner's research has shown non-invasive stimulation of the vagus nerve help people with PTSD.

- Well, for PTSD, we found a 31% reduction in PTSD symptoms compared to the sham controls.

- [Jaye] The vagus nerve runs from the brainstem to the abdomen and communicates with nearly all the organs of the body.

When activated, it triggers a relaxation response in the body, helping to lower heart rate, reduce blood pressure, and improve digestion.

Bremner's latest research into vagal nerve stimulation, VNS, is to see if it can help people with opioid use disorder.

Researchers have found similarities between PTSD and opioid use disorder.

- That they were doing studies of monkeys where they would show that the norepinephrine system, the locus coeruleus, which is in the brainstem, is overactive in both disorders.

- [Jaye] The overreaction of the locus coeruleus affects brain areas that drive craving.

- The craving for drugs is physiological.

It is guaranteed to happen if you've been using opioids for a long period of time.

You're gonna have that effect of the withdrawal.

- [Jaye] The sympathetic nervous system, the fight or flight response, becomes overactive when someone is in withdrawal.

People may experience intense cravings, high heart rate, high blood pressure, sweating, muscle aches, anxiety, insomnia.

Activating the vagus nerve, which is part of the parasympathetic nervous system, serves as the brake on fight or flight.

Dr. Bremner says a pilot study for opioid use disorder already showed vagus nerve stimulation decreased craving, pain, and lowered heart rate.

- We see acute pain commonly in people in acute withdrawal, and we showed that there was a greater than 20% reduction in pain that was statistically significant even just with this small pilot study.

- [Jaye] Stephen Brannan is part of the new larger study of over 100 people that includes coordinators and students from Emory and Georgia Tech.

- How do you align with, "I feel anxious"?

- I'd say two.

- [Technician] How bad are your withdrawal symptoms?

- Probably about 70.

- [Jaye] Brannan will be in the hospital for a week, and while he is there, he will use a vagus nerve stimulation device (device chirping) that is either the real thing or fake.

- There's nothing to it.

- [Jaye] He will do this four times a day.

- Being a carrier isn't all that bad.

- [Jaye] On day two, Brannan watches a control video of a postal worker four times.

- Postman video, post lady, excuse me, boring.

(tense music) - [Jaye] On the third day, he watches a video depicting drug use four times.

(tense energetic music) - [Device] Keep thinking about how badly you wanted to use and how good it felt to finally get that sensation.

- [Jaye] Before and after the videos, Brannan answers a series of questions.

- How much anxiety do you have?

- About 80.

- [Device] Now exhale slowly through your mouth.

- [Jaye] On the second and third days, the days Brannan watches the postal worker video and the drug use video, he has his blood drawn 10 times each day.

- How much pain- - Researchers are looking for different inflammatory and stress biomarkers to see how their levels are affected during fake or real vagal nerve stimulation.

- There's also some evidence that people going through withdrawal also have an activation of this inflammatory system.

So what we're looking at is whether VNS can block that.

(somber music) That first week of opioid withdrawal is very dangerous 'cause if people go back and use, their opioid receptors have started to shift, and they're at a high risk of overdose death because they're gonna go back and use the same amount, and then their brain is not responding to it the same way.

And so that's the danger period, is the first week.

- [Stephen] And I fell asleep behind the wheel, went over the side of the mountain.

Three quarters way down, hit an oak tree.

- [Jaye] It was a long-ago crash and over a year hospitalized that Brannan says got him addicted to prescription painkillers.

- It just hit.

Don't wanna go through that again.

The memories are like core memories.

- [Jaye] So far, Brannan's time in the hospital going through withdrawal has had its ups and downs.

- [Stephen] Rough off and on.

- [Jaye] He says he is committed to trying a different way because the cost to his life has been too great.

- If one person could get something out of what I'm doing, all that I've gone through, I mean, being homeless, losing everything, all that was worth it.

- [Jaye] At the end of the week, Brannan is sent home with a vagus nerve stimulation device to use twice a day plus a prescription for the medication assisted treatment drug suboxone.

- Here are four vagus nerve exercises.

- [Doug] If you go look on TikTok or YouTube, you'll see a lot of people doing what I would call hacks of the vagus nerve system, whether it's plunging your arm into a bucket of ice water or doing variations on trying to affect your breathing.

- I'm gonna teach you how to reset your nervous system.

- [Jaye] Indeed, the vagus nerve has struck a nerve on social media, with people seeking stress relief and wellbeing.

Exercises like deep breathing or cold exposure are popular.

- [Creator] So I went ahead and filled my dish here with ice.

- [Doug] It is true that you can activate your vagus through manipulating your breathing and doing other things.

- Can Pulsetto really help with stress, anxiety, and sleep?

- [Jaye] Companies are now making vagus nerve stimulation devices that don't have medical advertising, but describe them as lifestyle enhancers.

- Yeah, that's pretty much it.

- [Jaye] Five weeks later, we meet with Brannan again.

Have you used opioids since we saw you five weeks ago?

- No.

- [Jaye] You haven't used any?

- No.

- [Jaye] How about craving for them?

- A little bit.

(device chirping) - [Jaye] He says while he's not used the VNS device at home as much as he's supposed to, it definitely made a difference.

- It actually helped chill me out.

It helped relax my nerves.

It put me more at ease, especially with during the withdrawal.

- [Jaye] Vagus is the Latin word for wanderer.

This traveling nerve is proving to have potent benefit in many ways.

- You know, it's a non-invasive intervention that doesn't have any side effects that I've seen.

It kind of works for everything, and it's almost like kind of a magic treatment.

- The CDC reports almost a quarter of adults in the US experience chronic pain, defined as occurring on most days or every day in the past three months.

Our final story tonight highlights research that shows how non-invasive stimulation can address chronic pain and other wounds of war.

- [Charles] We were out there in the desert.

- Charles Parrott was a 23-year-old Marine Corps corporal assigned to data processing.

(explosion roaring) This Gulf War veteran was in the direct path when oil wells were set on fire.

- And the black smoke from the oil wells started to pollute the air.

We were literally in the path of that.

It literally covered us.

- [Jaye] Parrott returned home to Atlanta, Georgia in 1991, a young man with his life in front of him.

But in the years that followed, his health fell apart.

- I mean, there would be days where I'd be in so much pain, I would be curled up in a fetal position on my living room floor.

Because the pain was just so intense, living was almost not doable.

- Whenever he would bring up a symptom that was consistent with fibromyalgia, he said that they would say, "Oh, that's interesting," and then just move on because there really wasn't anything that they could do about it.

- [Jaye] To Dr. Anna Woodbury, Parrott's symptoms made perfect sense.

As the vice chair of research in anesthesiology at the Veterans Administration in Atlanta- - So this is still the- - [Jaye] She's a trained anesthesiologist- - [Anna] We're gonna put those two ends together.

- [Jaye] Pain management physician.

- So then we go over here.

- [Jaye] And researcher- - Oh, it didn't sample.

- [Jaye] Who studies chronic widespread pain syndromes.

- My first experience with Dr. Woodbury was pretty much life-altering.

She was the first doctor, who when I said what I'd been saying for 10 years, goes, "Yep, that's fibromyalgia."

- I think there's enough research now to acknowledge that fibromyalgia is something real.

It's not just chronic pain.

It's chronic pain and neurocognitive symptoms, including fatigue, cognitive disturbances, difficulty sleeping, depression.

- [Jaye] The syndrome was long thought to affect more women than men.

- I talked to an older physician.

Back in his training, it was thought of as middle-aged housewife syndrome.

People who are clinicians didn't know what was going on.

They couldn't explain it.

They didn't have good treatments for it.

So it was easier to just say, "Oh, well, it's all in your head."

And now we see that it's actually in the brain.

- [Jaye] Woodbury, a drug expert, wanted to find non-drug therapies that could help her patients.

She did.

- My goal is to try to offer them something that really treats their pain that is not so risky so that they're getting what they need for their pain control without having many of the physiologic side effects of dependence or potential abuse or overdose.

- [Charles] They supply a mild electrical shock through your body.

For me, I use it to help me fall asleep.

- [Jaye] Parrott uses an Alpha Stim device every day at home.

It delivers electrical currents through clips placed on his ears.

- [Charles] It helps calm my mind to a point where I'm more relaxed and can fall asleep.

- [Jaye] A lot of Dr. Woodbury's research focuses on neuromodulation, a non-invasive approach that delivers stimulation to parts of the nervous system that communicate with the brain and help alleviate symptoms.

- This particular device is called Alpha Stim because the device delivers a alpha frequency stimulation.

And alpha waves are the brainwaves that your brain makes when you are in a light trance or when you're about to fall asleep.

I like to tell people that this device is equivalent to inducing a meditation.

- We had one Humvee for 38 marines.

- [Jaye] Gulf War syndrome, a cluster of often debilitating symptoms, has dramatic overlap with fibromyalgia, and they are often considered one and the same.

- Gulf War syndrome is essentially fibromyalgia.

- [Jaye] A VA study found that those deployed to the Gulf in 1990 to 1991 had an increased risk of fibromyalgia.

In people with fibromyalgia, the sympathetic nervous system, which increases the fight or flight response, is overactivated.

The parasympathetic nervous system, which serves as a brake on fight or flight and leads to a rest and relax response, can be activated by neuromodulation, calming the body and reducing symptoms.

- There's something called the default mode network, and the default mode network is what areas of your brain are activated when you're not doing anything.

And this is kind of your sense of self.

And what happens in fibromyalgia is that the areas of the brain involved in the emotional and pain-processing pathways like the insula, they start lighting up at the same time as areas of the default mode network.

So in a sense, pain has become part of your sense of self.

So when we treat fibromyalgia effectively, we can actually see a decrease in connectivity between these areas of the brain that really shouldn't be talking to each other.

- [Jaye] Dr. Woodbury's patients have an arsenal of neuromodulation devices to help them deal with the aftereffects of war.

There is an IB-Stim device.

- [Anna] The IB-Stim device I think is mostly mediated through the effects on the vagus nerve.

- [Jaye] IB-Stim works by sending electrical impulses that stimulate nerve pathways connected to pain relief.

- We do these needles in a certain order.

- [Jaye] There is battlefield acupuncture.

- Battlefield acupuncture is essentially a series of points in the ear.

It's very easy to do.

It's very easy to train people to do.

It's just five points, and they just go one, two, three, four, five, like that.

- [Jaye] As the name suggests, it was designed to be done on the battlefield to alleviate the wounds of war.

- [Adrienne] I served in the Air Force.

Yeah, that's pretty good.

- [Jaye] And there is RTMS, repetitive transcranial magnetic stimulation.

- [Technician] Roughly three minutes.

- [Jaye] FDA approved for major depressive disorder, OCD, migraines, and smoking cessation, it uses electromagnetic signals, (device clicking) the magnet creating an electric impulse that goes deep into targeted areas of the brain.

- Then I went to the Gulf War.

We had a Army camp across from us.

They would burn their waste or garbage for the day.

So it was a lot of burning across from our camp.

- [Jaye] Adrienne Jones Atkinson says RTMS has helped debilitating migraines.

- I appreciate it because I'm not a person that likes to take pills.

- [Jaye] Parrott's service to his country cost him, but he's reclaimed his health thanks to a researcher who believed him and who helped him.

- [Charles] I praise Dr. Woodbury every day of my life because without her, I don't know where I would've been.

(soft music) - Thanks for joining us this week.

See you next time on "Your Fantastic Mind."

(energetic music) - [Announcer] "Your Fantastic Mind" brought to you in part by Sarah and Jim Kennedy.