Non-invasive Brain Stimulation Modalities for the Treatment and Prevention of Opioid Use Disorder: A Systematic Review of the Literature
Author: Jonathan R Young 1, Shayan A Smani 2, Nicholas A Mischel 3, Michael D Kritzer 4, Lawrence G Appelbaum 1, Ashwin A Patkar 1
Affiliation:
1 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
2 Trinity College of Arts and Sciences, Duke University, Durham, NC, USA.
3 Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
4 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Conference/Journal: J Addict Dis
Date published: 2020 Apr-Jun
Other:
Volume ID: 38 , Issue ID: 2 , Pages: 186-199 , Word Count: 268
PMID: 32469286 DOI: 10.1080/10550887.2020.1736756
Abstract
The U.S. is currently facing an unprecedented epidemic of opioid-related deaths. Despite the efficacy of the current treatments for opioid use disorder (OUD), including psychosocial interventions and medication-assisted therapy (MAT), many patients remain treatment-resistant and at high risk for overdose. A potential augmentation strategy includes the use of non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and auricular vagus nerve stimulation (aVNS). These approaches may have therapeutic benefits by directly or indirectly modulating the neurocircuitry affected in OUD. In this review, we evaluate the available studies on NIBS in the context of OUD withdrawal and detoxification, maintenance, and cravings, while also considering analgesia and safety concerns. In the context of opioid withdrawal and detoxification, a percutaneous form of aVNS has positive results in open-label trials, but has not yet been tested against sham. No randomized studies have reported on the safety and efficacy of NIBS specifically for maintenance treatment in OUD. TMS and tDCS have demonstrated effects on cravings, although published studies were limited by small sample sizes. NIBS may play a role in reducing exposure to opioids and the risk of developing OUD, as demonstrated by studies using tDCS in an experimental pain condition and TMS in a post-operative setting. Overall, while the preliminary evidence and safety for NIBS in the prevention and treatment of OUD appears promising, further research is needed with larger sample sizes, placebo control, and objective biomarkers as outcome measures before strong conclusions can be drawn.
Keywords: Opioid use disorder; non-invasive brain stimulation; review; transcranial direct current stimulation; transcranial magnetic stimulation.
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