193: Transcutaneous Electrical Nerve Stimulation to Support Buprenorphine Therapy in Opioid Use Disorder

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Non-pharmacological treatments, Pain in Special Populations

Background and Aims: Opioid use disorder (OUD) affects more than two million people in the United States, yet only one‑third receive pharmacologic treatment such as buprenorphine. Even with optimal dosing, many continue to experience withdrawal, craving, and pain, which undermine treatment retention. Because pain and addiction share overlapping neurobiological pathways, including impaired descending inhibition, non‑pharmacologic strategies that modulate these circuits are needed. Transcutaneous Electrical Nerve Stimulation (TENS) activates descending inhibitory pathways and may reduce both pain and addiction‑related symptoms. This pilot study evaluated the feasibility and preliminary effect of a 6‑week TENS intervention on pain, withdrawal, and craving among individuals receiving buprenorphine.

Methods: This prospective pilot study recruited adults with opioid use disorder (OUD) receiving buprenorphine from two Midwestern treatment facilities. Participants were provided with a TENS device (100 Hz, 100 μs) and instructed to use it regularly over a 6‑week period while continuing standard care. Data were collected at baseline and weeks 1, 2, 4, and 6 using validated measures of pain severity, pain interference, opioid withdrawal, and craving. Feasibility and acceptability were assessed through structured interviews at week 6. Changes from baseline to week 6 were analyzed using Wilcoxon signed‑rank tests with significance set at p < .05.

Results: Nineteen participants enrolled in the study (mean age 49 years, SD = 15.4; 12 female; 14 White, 4 Black/African American, 2 Hispanic). Participants reported an average of 9.9 years of OUD before treatment and 2.0 years on buprenorphine. From baseline to week 6, craving scores decreased by a mean of 1.9 (SD = 2.1, p = .01), and withdrawal scores decreased by 3.9 (SD = 3.4, p = .002). Pain severity and pain interference showed reductions that approached significance. Qualitative interviews indicated that TENS was usable, acceptable, and associated with perceived improvements in pain, withdrawal, and craving.

Conclusions: This pilot study demonstrates that Transcutaneous Electrical Nerve Stimulation (TENS) is a feasible and acceptable adjunctive intervention for individuals with opioid use disorder receiving buprenorphine. Participants reported meaningful reductions in craving and withdrawal, with pain severity and interference showing trends toward improvement. Qualitative feedback supported the usability and perceived benefits of TENS for managing symptoms that often undermine treatment retention. These preliminary findings suggest that integrating a non‑pharmacologic neuromodulation strategy with medication‑assisted treatment may enhance outcomes for people living with OUD and pain. Larger controlled studies are warranted to confirm effectiveness and guide clinical implementation.

References: Bailey AJ, Votaw VR, Weiss RD, McHugh RK. Capturing the full range of buprenorphine treatment response. JAMA Psych. 2024;e243836. Doi: 10.1001/jamapsychiatry.2024.3836

Vance CG, Dailey DL, Chimenti RL, VanGorp BJ, Sluka KA. Using TENS for pain control: update on the state of the evidence. Medicina. 2022;58:1332.doi.org/10.3390/medicine58101332

Gowing L, Ali R, White JM, Mbewe D. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev. 2017;2:CD002025.

Presenting Author: Carol GT Vance
Submitting Author: Carol Vance

Senior Author: Barbara St. Marie

IASP 2026 Global Year theme of Neuropathic Pain: No

• Barbara St. Marie: PhD, RN - University of Iowa
• Jamie Morton: PhD, RN - University of Iowa
• Alison Lynch: MD - University of Iowa
• Shaoshuai Chen: Doctoral Student, MS, BSN, RN - University of Iowa
• Yelena Perkhounkova: PhD - University of Iowa
• Jihye Lee: PhD, RN - University of Iowa
• Peter Abad: RN, MSc - University of Iowa
• Maria Hein: MSW - University of Iowa
• Nayung Youn: NP, Doctoral student - University of Iowa