Abstract
Background: Opioid craving presents as an irresistible urge to take or as intense thoughts about opioid. The aim of this study to examine the change in craving following high frequency rTMS stimulation of the right dorsolateral prefrontal cortex (DLPFC) in patients with opioid dependence.
Material & Methods: This is a prospective, hospital-based, randomized, sham-controlled transcranial magnetic stimulation study conducted at the Centre of Cognitive Neurosciences Department of Central Institute of Psychiatry (C.I.P.), Ranchi, India. The hospital has bed strength of 673 with more than 53,500 patients attending the outpatient clinic every year. The selected 40 patients were divided into active and sham group by purposive sampling. Written informed consent was obtained from the patient prior to the study after explaining the procedure in detail.
Results: The active group consists of 30 patients in the age range of 25.06(5.55) years while the sham control group had 10 patients with age range of 26.40(7.87) years. The comparison of mean scores of Temperament and character dimensions between active and sham group, there was significant difference found in harm avoidance (p 0.50) between active compared to sham groups with no other dimensions showing significant difference seen. The comparison of mean scores of active and sham with ASI Subscales, no significant difference was observed between the two groups on all the dimensions.
Conclusion: We concluded that High frequency right prefrontal rTMS was found to have short-term anti-craving effects and trend towards sustaining the effects in opioid dependent patients.
Keywords: Opioid craving, rTMS, dorsolateral prefrontal cortex, ASI, OCDUS
References
- Oscar-Berman, M., and Marinković, K. Alcohol: effects on neurobehavioral functions and the brain. Neuropsychology Review.2007; 17(3), 239-257.
- Singleton, E. G., Tiffany, S. T. and Henningfield, J. E. The Alcohol Craving Questionnaire (ACQ-NOW). In J. P. Allen and V. B. Wilson (eds.) Assessing Alcohol Problems: A Guide for Clinicians and Researchers, 2nd ,2003; 271-281. NIH Publication No. 03-3745. Bethesda, M.D.: National Institute on Alcohol Abuse and Alcoholism.
- Park, M. S., Sohn, J. H., Suk, J. A et al. Brain substrates of craving to alcohol cues in subjects with alcohol use disorder. Alcohol and Alcoholism,2007; 42(5), 417-422.
- Boggio, P. S., Sultani, N., Fecteau, S., et al. Prefrontal cortex modulation using transcranial DC stimulation reduces alcohol craving: A double-blind, sham- controlled study. Drug and Alcohol Dependence,2008; 92, 55-60.
- Drummond, D. C. Theories of drug craving, ancient and modern. Addiction,2001; 96 (1), 33-46.
- Baker, T., Morse, E. and Sherman, J. The motivation to use drugs: a psychobiological analysis of urges. Nebraska Symposium on Motivation,1986; 34, 257–323.
- Wassermann, E. M., Grafman, J., Berry, C., et al. Use and safety of a new repetitive transcranial magnetic stimulator. Electroencephalography and Clinical Neurophysiology,1996; 101(5), 412-417.
- Pascual-Leone, A., Houser, C. M., Reese, K., et al. Safety of rapid-rate transcranial magnetic stimulation in normal volunteers. Electroencephalography and Clinical Neurophysiology,1993; 89(10), 120-130.
- Nahas, Z., McConnell, K. C. S., Molloy, M., et al (1999) Could left prefrontal rTMS modify negative symptoms and attention in schizophrenia? Biological Psychiatry, 45, 37S
- Rollnik, K. D., Huber, T. J. and Mogk, H. (2000) High-frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex in schizophrenic patients. Neuroreport, 11(7), 4013-4015.
- Saba, G., Schurhoff, F. and Leboyer, M. (2006) Therapeutic and neurophysiologic aspects of transcranial magnetic stimulation in schizophrenia. Clinical Neurophysiology, 36, 185–194.
- Grisaru, N., Chudakov, B., Yaroslavsky, Y., et al (1998) Transcranial magnetic stimulation in mania: a controlled study. American Journal of Psychiatry, 155, 1608-1610.
- Sachdev, P. S., McBride, R., Loo, C. K., et al (2001) Right versus left prefrontal transcranial magnetic stimulation for obsessive-compulsive disorder: a preliminary investigation. Journal of Clinical Psychiatry, 62, 981-984.
- Mantovani, A., Lisanby, S. H., Pieraccini, F., et al Repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of Panic Disorder (PD) with comorbid major depression. Journal of Affective Disorders,2007; 15, 15-21.
- Osuch, E. A., Benson, B. E., Luckenbaugh, D. A., et al Repetitive TMS combined with exposure therapy for PTSD: A preliminary study. Journal of Anxiety Disorders,2008; 23, 54-59.
- Franken I. H. A. Behavioral approach system (BAS) sensitivity predicts alcohol craving. Personality and Individual Differences,2002; 32, 349–355.
- Anton R. (1999). What is craving: models and implications for treatment. Alcohol Research and Health, 23, 165–173.
- Cloninger, C. R., Przybeck., T, R., Svrakic, D. M., et al (1994) A psychobiological model of temperament and character. Archives of General Psychiatry, 50, 975-990.
- Camprodon, J. A., Martinez-Raga, J., Alonso-Alonso, M., et al (2007). One session of high frequency repetitive transcranial magnetic stimulation (rTMS) to the right prefrontal cortex transiently reduces cocaine craving. Drug Alcohol Dependence, 86, 91–94.
- Eichhammer, P., Johann, M., Kharraz, A., et al (2003) High-frequency repetitive transcranial magnetic stimulation decreases cigarette smoking. Journal of Clinical Psychiatry, 64, 951–953
- George, M. S., Stallings, L. E. and Speer, A. M. (1999b). Prefrontal repetitive transcranial magnetic stimulation (rTMS) changes relative perfusion locally and remotely. Human Psychopharmacology Clinical Experiment, 14(1), 161–170.
- Mishra B. R., Nizamie S. H., Das B., (2010). Efficacy of repetitive transcranial magnetic stimulation in alcohol dependence: a sham-controlled study. Addiction 105, 49–55.
- Erhardt, A., Sillaber, I., Welt, T., et al (2004) Repetitive Transcranial Magnetic Stimulation Increases the Release of Dopamine in the Nucleus Accumbens Shell of Morphine-Sensitized Rats During Abstinence. Neuropsychopharmacology 29, 2074–2080
Corresponding Author
Dr Bhanu Pratap Singh
Senior Resident Dept of Psychiatry, Govt. Medical College and Bangar Hospital Pali, Rajasthan, India