Effect of Transcutaneous Vagus Nerve Stimulation in Erosive Hand Osteoarthritis: Results from a Pilot Trial

Abstract

Beyond its effect on vegetative functions, the activation of the vagus nerve inhibits inflammation and reduces pain signaling. The aim of this open-label pilot study was to determine the efficacy and tolerance of transcutaneous auricular VNS (taVNS) on erosive hand osteoarthritis (EHOA) symptoms. Symptomatic EHOA patients with hand pain VAS ≥ 40/100 mm and ≥1 interphalangeal swollen joint(s) were included. The taVNS was performed for 4 weeks using an auricular electrode applied one hour per day and connected to a TENS device with pre-established settings. Clinical efficacy was evaluated by changes between baseline and at 4 weeks with hand pain VAS and the functional index FIHOA score, using a Wilcoxon t-test. The treatment tolerance was also evaluated. Eighteen patients (median age 69 years old, 83% women) were analyzed. At baseline, hand pain VAS was 60 mm [IQR 50; 78.2] and FIHOA 15 [10.7; 20.2]. After 4 weeks, taVNS significantly reduced hand pain VAS, with a median decrease of 23.5 mm [7.7; 37.2] (p = 0.001), as well as FIHOA, with a median decrease of 2 points [0.75; 5.2] (p = 0.01). No serious adverse events were reported. One patient stopped taVNS because of auricular discomfort. This first proof-of-concept trial indicated that taVNS is feasible and may decrease joint inflammation and clinical symptoms in EHOA, arguing for a randomized controlled study versus sham stimulation.

Klinische Wirksamkeit der aurikulären Vagusnervstimulation in der Behandlung chronischer und akuter Schmerzen

“…1 -und Kontrolle), Stimulationsparameter, Behandlungsdauer, primäre und sekundäre Ergebnisse sowie beobachtete unerwünschte Ereignisse. [30,40,41,49,53,64,69], n = 154), Migräne (4 Studien [24,39,70,84], n = 133), Rückenschmerz (4 Studien [39,65,66,71], n = 192), rheumatoide Arthritis (RA)/Osteoarthritis (2 Studien [17,46]; n = 45), Fibromyalgie/ systemischer Lupus Erythematodes (SLE) (3 Studien [5,43,79], n = 51), Chemotherapie-induzierte periphere Neuropathie (1 Studie [62]; n = 58), unspezifischer chronischer Schmerz (1 Studie [30], n = 3). Von diesen waren 9 Studien [5,40,41,43,65,66,69,70,84] Schmerz auf einer Visuellen Analogskala (VAS) oder Numerischen Rating-Skala (NRS), psychisches Wohlbefinden und Verträglichkeit/Sicherheit der Stimulation waren die häufigsten primären und sekundären Endpunkte.…”

“…In 8 Studien [17,24,49,62,65,66,70,71] wurde der Bedarf an Schmerzmit-teln erhoben. In 6 dieser Studien (davon 3 bei chronischem Rückenschmerz und 1 bei chronischer Migräne) [49,62,65,66,70,71] konnte die Schmerzmitteleinnahme in der aVNS-Gruppe reduziert werden.…”

Effect of Transcutaneous Auricular Vagus Nerve Stimulation Addition on Disability in Chronic Low Back Pain Patients: A Randomized Controlled Study

“…There was a significant reduction in NPRS score after 1 week of stimulation (P < 0.001), after 2 weeks of stimulation (P < 0.001), and after 3 weeks of stimulation (P < 0.001). 26 A study was conducted by Courties et al about the effect of tVNS on hand osteoarthritis. Eighteen patients who fulfilled the American College of Rheumatology (ACR) criteria of hand osteoarthritis received tVNS located in cymba conchae, 1 h/day at 25 Hz, intensity increased gradually with patient tolerance, and pulse width 50 μs for 4 weeks.…”

Transcutaneous vagus nerve stimulation in erosive hand osteoarthritis: protocol for the randomised, double-blind, sham-controlled ESTIVAL trial

“…In an open-label pilot study, we showed that 1-hour auricular tVNS per day significantly decreased pain and the number of tender and swollen joints and improved function in 18 patients with EHOA, but more importantly was well tolerated 28. However, the low number of patients and no control group could not allow us to rule out a placebo effect for effectiveness.…”