A randomized effectiveness trial of methadone, TENS and methadone plus TENS in management of opiate withdrawal symptoms.

Objective: To compare effectiveness of methadone, TENS (Transcutaneous Electrical Nerve Stimulation) and methadone+ TENS in management of opiate withdrawal symptoms. Methods: The study was conducted in Zahedan Psychiatric center in 2005. Forty five opiate addicted men meeting DSM-IV criteria for substance dependency disorder participated in the study after informed consent. The subjects were randomly assigned to 3 treatment groups. Patients of first group were given 20-60 mg methadone daily, tapered over a period of 2 weeks. Patients of second group received daily 10-30mg methadone, tapered similar to first group in combination with TENS treatment. The other 15 patients (third group) experienced low frequency (2 Hz) TENS for two weeks. Results: There was no statistically significant difference in severity and number of withdrawal symptoms between the 3 groups prior to the start of treatments. But, severity and number of symptoms were significantly higher in TENS group (third group) in third day. In addition, 10 patients of TENS-group left the treatment programme after 5 days. The results showed that methadone only and Methadone plus TENS for the management of opioid detoxification were effective treatments. The comparison of number and severity of withdrawal symptoms in the methadone group and methadone+TENS group by seventh day didn't show significant differences. But, number and severity of withdrawal symptoms in methadone+TENS group were significantly lower than methadone group during tenth and fourteenth days. Conclusion: The results provide support for the use of methadone alone and methadone plus TENS for managing opiate withdrawal, but TENS by itself has no significant effect on withdrawal symptoms. However, TENS in combination with a moderate dose of methadone could reduce severity of withdrawal symptoms effectively.