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Transcranial focused ultrasound (tFUS): a promising noninvasive deep brain stimulation approach for pain

Neuropsychopharmacology volume 49, pages 351–352 (2024)Cite this article

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Pain is a complex experience that involves sensory, emotional, and motivational dimensions. There are several cortical and subcortical brain structures that contribute to this complexity, including the somatosensory cortex, thalamus, insula, amygdala, and prefrontal cortex. Presently, the most reliable anti-pain effects are elicited via opioids binding at nociception structures to elicit reductions in pain. With the proliferation of opioids, and their serious side effects and potential for abuse, alternative interventions like noninvasive brain stimulation targeting these pain-related brain regions could provide an alternative solution [1].

Transcranial focused ultrasound (tFUS) has emerged as a promising new technology that is both noninvasive and deep in its bioeffects [3]. tFUS utilizes piezoelectric transducers generating ultrasonic waves that summate deep in the brain. These ultrasonic forces have a deeper penetration range and more focal resolution than TMS (Depth: tFUS ≈ 1–12 cm, TMS ≈ 1–4 cm; Focality: tFUS < 1 cm, TMS < 3 cm). tFUS, when delivered at a high intensity (1000 W), ultrasound causes tissue heating (thermoablation), and thus permanent, irreversible lesions, which has clinical utility. At lower intensities (<50 W), ultrasound allows for stimulation of tissue without heating, which can be used for excitatory or inhibitory neuromodulation. Prior research has established parameter safety limits for tFUS in single-sessions, which are further reinforced by guidelines set forth by the US FDA. However, further preclinical and human safety trials are needed to establish long-term tFUS safety, in light of optimization needed to improve efficacy [4], including increasing sonication time (maximum safe session length), cumulative effects (maximum safe number of repeated sessions), and power (maximum safe wattage).

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Fig. 1: Ultrasound can modulate deep brain structures associated with pain.

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Funding

NIDA P50DA046373-05. NINDS RM1NS128787-01.

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  1. Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA

    Bashar W. Badran & Xiaolong Peng

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  1. Bashar W. Badran
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  2. Xiaolong Peng
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BWB and XP both drafted and edited the article and approve the final version.

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Correspondence to Bashar W. Badran.

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Badran, B.W., Peng, X. Transcranial focused ultrasound (tFUS): a promising noninvasive deep brain stimulation approach for pain. Neuropsychopharmacol. 49, 351–352 (2024). https://doi.org/10.1038/s41386-023-01699-w

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