Author: Valton Costa1,2, Anna Carolyna Gianlorenço1,2, Maria Fernanda Andrade2, Lucas Camargo2, Maryela Menacho1,2, Mariana Arias Avila3, Kevin Pacheco-Barrios2,4, Hyuk Choi5,6, Jae-Jun Song6,7, Felipe Fregni2
Affiliation: <sup>1</sup> Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil.
<sup>2</sup> Spaulding Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
<sup>3</sup> Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil.
<sup>4</sup> Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
<sup>5</sup> Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, South Korea.
<sup>6</sup> Neurive Co, Ltd, Gimhae, South Korea.
<sup>7</sup> Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul, South Korea.
Conference/Journal: Pain Rep
Date published: 2024 Aug 7
Other:
Volume ID: 9 , Issue ID: 5 , Pages: e1171 , Special Notes: doi: 10.1097/PR9.0000000000001171. , Word Count: 235
Chronic pain is one of the major causes of disability with a tremendous impact on an individual's quality of life and on public health. Transcutaneous vagus nerve stimulation (tVNS) is a safe therapeutic for this condition. We aimed to evaluate its effects in adults with chronic pain. A comprehensive search was performed, including randomized controlled trials published until October 2023, which assessed the effects of noninvasive tVNS. Cohen's d effect size and 95% confidence intervals (CIs) were calculated, and random-effects meta-analyses were performed. Fifteen studies were included. The results revealed a mean effect size of 0.41 (95% CI 0.17-0.66) in favor of tVNS as compared with control, although a significant heterogeneity was observed (χ2 = 21.7, df = 10, P = 0.02, I 2 = 53.9%). However, when compared with nonactive controls, tVNS shows a larger effect size (0.79, 95% CI 0.25-1.33), although the number of studies was small (n = 3). When analyzed separately, auricular tVNS and cervical tVNS against control, it shows a significant small to moderate effect size, similar to that of the main analysis, respectively, 0.42 (95% CI 0.08-0.76, 8 studies) and 0.36 (95% CI 0.01-0.70, 3 studies). No differences were observed in the number of migraine days for the trials on migraine. This meta-analysis indicates that tVNS shows promise as an effective intervention for managing pain intensity in chronic pain conditions. We discuss the design of future trials to confirm these preliminary results, including sample size and parameters of stimulation.
Keywords: Chronic pain; Meta-analysis; Neuromodulation; Transcutaneous vagus nerve stimulation.
PMID: 39131814 PMCID: PMC11309651 DOI: 10.1097/PR9.0000000000001171