Review of the Uses of Vagal Nerve Stimulation in Chronic Pain Management

Chakravarthy, Krishnan; Chaudhry, H. S.; Williams, Kayode; Christo, Paul J.

doi:10.1007/s11916-015-0528-6

Cited by 128 publications

(111 citation statements)

References 78 publications

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“…During the recent past, a considerable research effort has been afforded to investigate the analgesic potential of VNS 33. Traditionally, it is thought that visceral pain afferent information is primarily conducted via spinal afferents although there is an increasing appreciation that the ANS is involved in pain genesis in maintenance across a number of chronic pain syndromes including CP 16,18,34.…”

Section: Discussionmentioning

confidence: 99%

Acute physiological and electrical accentuation of vagal tone has no effect on pain or gastrointestinal motility in chronic pancreatitis

Juel¹,

Brock²,

Olesen³

et al. 2017

JPR

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BackgroundThe effective management of pain in chronic pancreatitis (CP) remains a therapeutic challenge. Analgesic drugs, such as opioids, and the underlying pathology can impair gut function. The autonomic nervous system influences hormone secretion and gut motility. In healthy volunteers, electrical (using noninvasive transcutaneous vagal nerve stimulation [t-VNS]) and physiological (using deep slow breathing [DSB]) modulation of parasympathetic tone results in pain attenuation and enhanced gut motility. Thus, the aims were to investigate whether t-VNS and DSB could enhance the parasympathetic tone, decrease pain sensitivity and improve gut motility in CP.Patients and methodsA total of 20 patients (12 males, mean age=61 years, range: 50–78 years) with CP were randomized to short-term (60 minutes) t-VNS and DSB, or their placebo equivalent, in a crossover design. Cardiometrically derived parameters of autonomic tone, quantitative sensory testing of bone and muscle pain pressure, conditioned pain modulation (CPM) and assessments of gastroduodenal motility with ultrasound were performed.ResultsIn comparison to sham, t-VNS and DSB increased cardiac vagal tone (CVT) (P<0.001). However, no changes in pain pressure thresholds for bone (P=0.95) or muscle (P=0.45) were seen. There was diminished CPM (P=0.04), and no changes in gastroduodenal motility were observed (P=0.3).ConclusionThis explorative study demonstrated that t-VNS and DSB increased CVT in patients with CP. However, this short-lasting increase did not affect pain sensitivity to musculoskeletal pain or gastroduodenal motility. The chronic pain in CP patients is complex, and future trials optimizing neuromodulation for pain relief and improved motility are needed.

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Section: Discussionmentioning

confidence: 99%

Acute physiological and electrical accentuation of vagal tone has no effect on pain or gastrointestinal motility in chronic pancreatitis

Juel¹,

Brock²,

Olesen³

et al. 2017

JPR

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“…The same nerve collaborates to the formation and maintenance of the central pain memory, modulating inhibitory descendant pathways to nociceptive areas in the spinal cord [31]. Complete information are not available on these ascendant mechanisms (probably involving NTS, parabrachial nuclei, periaqueductal grey area, hypothalamus, limbic area, magnum raphe, locus ceruleus), as well as on descendant ones, but we can state that the vagal tone has an important influence on pain perception [32]. A compression of the vagus nerve can alter its function, just as a dysfunction of a peripheral nerve, mimicking an entrapment syndrome [33].…”

Section: New Hypotheses and Considerations On Chronic Pain And Psychimentioning

confidence: 99%

Depression, anxiety and chronic pain in patients with chronic obstructive pulmonary disease: the influence of breath

Bordoni

Marelli²,

Bruno

et al. 2017

Monaldi Arch Chest Dis

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Chronic obstructive pulmonary disease (COPD) is a major public health problems, causing significant mortality and morbidity in the world. It is a complex and progressive disease, characterized by chronic inflammation and dysfunction of the respiratory airways. The article reviews the available information on the potential role of the diaphragm in this disease. The purpose is to identify a potential correlation between symptoms such as depression, anxiety and chronic pain, frequently observed in COPD, with the activity of the diaphragm. The morphology and metabolism of the diaphragm are usually modified in the presence of COPD: a correlation between this symptoms and a pathological adaptation of breathing can be hypothesized. The management of these conditions should always be multidisciplinary, in order to have a global vision of the patient.

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“…Some data is emerging regarding the use of VNS, either invasive on non‐invasive, in fibromyalgia, pelvic pain, and headaches (see for review ). Lange et al .…”

Section: Therapeutic Implications: Activation Of Vagal Afferents/effementioning

confidence: 99%

Vagal tone: effects on sensitivity, motility, and inflammation

Bonaz

Sinniger

Pellissier

2016

Neurogastroenterology Motil

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The vagus nerve (VN) is a key element of the autonomic nervous system. As a mixed nerve, the VN contributes to the bidirectional interactions between the brain and the gut, i.e., the brain-gut axis. In particular, after integration in the central autonomic network of peripheral sensations such as inflammation and pain via vagal and spinal afferents, an efferent response through modulation of preganglionic parasympathetic neurons of the dorsal motor nucleus of the vagus and/or preganglionic sympathetic neurons of the spinal cord is able to modulate gastrointestinal nociception, motility, and inflammation. A low vagal tone, as assessed by heart rate variability, a marker of the sympatho-vagal balance, is observed in functional digestive disorders and inflammatory bowel diseases. To restore a normal vagal tone appears as a goal in such diseases. Among the therapeutic tools, such as drugs targeting the cholinergic system and/or complementary medicine (hypnosis, meditation…), deep breathing, physical exercise, VN stimulation (VNS), either invasive or non-invasive, appears as innovative. There is new evidence in the current issue of this Journal supporting the role of VNS in the modulation of gastrointestinal functions.

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Review of the Uses of Vagal Nerve Stimulation in Chronic Pain Management

Cited by 128 publications

References 78 publications

Acute physiological and electrical accentuation of vagal tone has no effect on pain or gastrointestinal motility in chronic pancreatitis

Acute physiological and electrical accentuation of vagal tone has no effect on pain or gastrointestinal motility in chronic pancreatitis

Depression, anxiety and chronic pain in patients with chronic obstructive pulmonary disease: the influence of breath

Vagal tone: effects on sensitivity, motility, and inflammation

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