Systematic review and meta-analysis: Combining transcranial magnetic stimulation or direct current stimulation with pharmacotherapy for treatment of substance use disorders

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions Pub Date : 2024-01-25 DOI:10.1111/ajad.13517

Nicholas L. Bormann MD, Tyler S. Oesterle MD, MPH, Stephan Arndt PhD, Victor M. Karpyak MD, PhD, Paul E. Croarkin DO, MS

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引用次数: 0

Abstract

Background and Objectives

Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have evidence for their potential in the treatment of substance use disorders (SUD). Medication for addiction treatment (MAT) is underutilized and not always effective. We identified randomized controlled trials (RCTs) and case studies that evaluated the effectiveness of TMS or tDCS used concurrently with MAT in SUD treatment.

Methods

A systematic review of published literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on 6/1/2023 by a medical librarian. Craving-related scales were extracted for an effect size calculation. The Physiotherapy Evidence Database (PEDro) scale assessed study quality.

Results

Eight studies (7 RCT, 1 case) including 253 individuals were published from 2015 to 2022, 5 of which had available data for meta-analysis. TMS or tDCS combined with MAT significantly reduced craving-related measures relative to sham stimulation (Hedges' g = −0.42, confidence interval: −0.73 to −0.11, p < .01). Opioid use disorder, methadone, and the dorsolateral prefrontal cortex were the most commonly studied SUD, MAT, and target region.

Discussion and Conclusions

Our results show a significant effect; however, is limited by a small number of studies with heterogeneous methodology across intervention methods and SUDs. Additional trials are needed to fully assess the clinical impact and mechanisms of combined brain stimulation and pharmacotherapy. We discuss a possible mechanism for synergism from these treatment combinations.

Scientific Significance

Adds the first systematic review of combination treatment with TMS or tDCS and MAT in SUD patients to the literature and estimates its overall effect size.

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系统回顾和荟萃分析：经颅磁刺激或直流电刺激与药物疗法相结合治疗药物使用障碍。

背景和目的：有证据表明，经颅磁刺激（TMS）和经颅直流电刺激（tDCS）具有治疗药物使用障碍（SUD）的潜力。药物成瘾治疗（MAT）未得到充分利用，而且并非总是有效。我们确定了随机对照试验 (RCT) 和病例研究，这些试验和研究评估了 TMS 或 tDCS 与 MAT 同时用于 SUD 治疗的有效性：一名医学图书管理员于 2023 年 1 月 6 日按照《系统综述和元分析首选报告项目》（PRISMA）指南对已发表的文献进行了系统综述。提取了与渴求相关的量表以计算效应大小。物理治疗证据数据库（PEDro）量表评估了研究质量：从2015年到2022年，共发表了8项研究（7项RCT，1项病例），涉及253人，其中5项研究的数据可用于荟萃分析。相对于假刺激，TMS 或 tDCS 联合 MAT 能显著降低渴求相关指标（Hedges' g = -0.42，置信区间：-0.73 至 -0.11，p 讨论和结论：我们的研究结果显示了明显的效果；但是，由于干预方法和 SUD 的研究数量较少，且方法不尽相同，因此效果有限。要全面评估脑刺激和药物疗法相结合的临床影响和机制，还需要进行更多的试验。我们讨论了这些治疗组合协同作用的可能机制：首次对TMS或tDCS与MAT联合治疗SUD患者的文献进行了系统回顾，并估算了其总体效应大小。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal on Addictions SUBSTANCE ABUSE-

CiteScore

5.00

自引率

0.00%

发文量

118

期刊介绍： The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.