Guldas Soner, Tumkaya Selim, Yucens Bengu
Department of Psychiatry, Gaziantep State Hospital, Gaziantep, Turkey.
Faculty of Medicine, Department of Psychiatry, Pamukkale University, Denizli, Turkey.
Addict Biol. 2025 Jun;30(6):e70057. doi: 10.1111/adb.70057.
Opioid use disorder (OUD) is a chronic, relapsing brain disorder. The efficacy of brain stimulation methods in the treatment of OUD has been increasingly investigated. However, the efficacy of deep transcranial magnetic stimulation, namely, wide-volume TMS, in the treatment of OUD has not been investigated. The aim of this randomized, double-blind, sham-controlled add-on study was to evaluate the efficacy of wide-volume TMS using a double-cone coil in participants with OUD. A total of 55 OUD patients were recruited and randomized to receive either active or sham TMS. Active wide-volume TMS treatment was applied to the left dorsolateral prefrontal cortex (DLPFC) in the active TMS group using a double-cone coil, twice daily for 2 weeks, at a frequency of 10 Hz. Sham TMS was also applied to the same region in the placebo group using a placebo coil. Opioid Craving Visual Analogue Scale (OC-VAS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS) and Barratt Impulsiveness Scale-11 (BIS-11) were measured before treatment, at the end of treatment, and 2 months after treatment. A total of 21 patients from the active TMS group and 19 patients from the sham TMS group completed the study. Although the active TMS group exhibited more reduction in craving and a less pronounced increase in buprenorphine-naloxone dose during the treatment period compared to the sham group, these differences did not reach statistical significance. This study suggests that while wide-volume TMS using a double-cone coil applied to the left DLPFC was well tolerated, it did not produce statistically significant improvements in craving, depression, anxiety, or impulsivity when compared to the sham treatment. However, the observed trends warrant further investigation with larger sample sizes and refined protocols. TRIAL REGISTRATION: THIS TRIAL WAS REGISTERED AT CLINICALTRIALS.GOV (NCT06081985).
阿片类物质使用障碍（OUD）是一种慢性复发性脑疾病。脑刺激方法在治疗OUD方面的疗效已得到越来越多的研究。然而，深部经颅磁刺激，即广域TMS，在治疗OUD方面的疗效尚未得到研究。这项随机、双盲、假对照附加研究的目的是评估使用双锥线圈的广域TMS对OUD患者的疗效。共招募了55名OUD患者，并随机分为接受活性或假TMS治疗组。活性TMS组使用双锥线圈对左侧背外侧前额叶皮质（DLPFC）进行活性广域TMS治疗，每天两次，持续2周，频率为10 Hz。安慰剂组也使用安慰剂线圈对同一区域进行假TMS治疗。在治疗前、治疗结束时和治疗后2个月测量阿片类物质渴求视觉模拟量表（OC-VAS）、汉密尔顿抑郁评定量表（HDRS）、汉密尔顿焦虑评定量表（HARS）和巴拉特冲动性量表-11（BIS-11）。活性TMS组的21名患者和假TMS组的19名患者完成了研究。尽管与假治疗组相比，活性TMS组在治疗期间渴求减少更多，丁丙诺啡-纳洛酮剂量增加不那么明显，但这些差异未达到统计学显著性。这项研究表明，虽然使用双锥线圈对左侧DLPFC进行广域TMS耐受性良好，但与假治疗相比，在渴求、抑郁、焦虑或冲动性方面并未产生统计学上显著的改善。然而，观察到的趋势值得用更大的样本量和完善的方案进行进一步研究。试验注册：本试验已在ClinicalTrials.gov注册（NCT06081985）。
