Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Neuromodulation. 2020 Apr;23(3):301-311. doi: 10.1111/ner.13108. Epub 2020 Feb 14.
BACKGROUND: There is a great public health need to identify novel treatment strategies for opioid use disorder (OUD) in order to reduce relapse and overdose. Noninvasive brain stimulation (NIBS) has demonstrated preliminary effectiveness for substance use, but little is known about its use in OUD. Neuromodulation may represent a potential adjunctive treatment modality for OUD, so we conducted a systematic review to understand the state of the current research in this field. METHODS: We conducted a systematic review of studies using noninvasive brain stimulation to affect clinical outcomes related to substance use for adults with opioid use disorder. We searched the following online databases: PubMed, The Cochrane Library, PsycINFO (EBSCOhost, 1872-present), and Science Citation Index Expanded (ISI Web of Science, 1945-present). All studies that measured clinical outcomes related to substance use, including cue-induced craving, were included. We assessed risk of bias using the Cochrane Handbook. RESULTS: The initial search yielded 5590 studies after duplicates were removed. After screening titles and abstracts, 14 full-text studies were assessed for eligibility. Five studies were determined to meet inclusion criteria with a combined total subjects of N = 150. Given the paucity of studies and small number of total subjects, no quantitative analysis was performed. These studies used TMS (n = 3), tDCS (n = 1), and the BRIDGE device (n = 1), a noninvasive percutaneous electrical nerve field stimulator, to reduce cue-induced craving (n = 3), reduce clinical withdrawal symptoms (n = 1), or measure substance-use-related cortical plasticity (n = 1). CONCLUSIONS: There is a dearth of research in the area of noninvasive brain stimulation for OUD. NIBS represents a novel treatment modality that should be further investigated for OUD.
背景:为了降低复吸和过量用药的风险,满足公众对阿片类药物使用障碍(OUD)新型治疗策略的巨大需求。非侵入性脑刺激(NIBS)已被证明对物质使用具有初步疗效,但对其在 OUD 中的应用知之甚少。神经调节可能是 OUD 的一种潜在辅助治疗方式,因此我们进行了系统评价,以了解该领域当前研究的状况。
方法:我们对使用非侵入性脑刺激来影响与阿片类药物使用障碍相关的临床结局的研究进行了系统评价。我们检索了以下在线数据库:PubMed、The Cochrane Library、PsycINFO(EBSCOhost,1872 年至今)和科学引文索引扩展版(ISI Web of Science,1945 年至今)。所有测量与物质使用相关的临床结局的研究,包括线索诱导的渴求,都被包括在内。我们使用 Cochrane 手册评估了偏倚风险。
结果:去除重复项后,初步搜索得到 5590 项研究。在筛选标题和摘要后,有 14 项全文研究被评估是否符合纳入标准。其中 5 项研究符合纳入标准,共有 N = 150 名受试者。由于研究数量少且受试者总数少,因此未进行定量分析。这些研究使用 TMS(n = 3)、tDCS(n = 1)和 BRIDGE 设备(n = 1),一种非侵入性经皮电神经场刺激器,以减少线索诱导的渴求(n = 3),减少临床戒断症状(n = 1)或测量与物质使用相关的皮质可塑性(n = 1)。
结论:OUD 领域的非侵入性脑刺激研究相对较少。NIBS 代表了一种新的治疗方式,应该进一步研究 OUD。
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