Meditative-based diaphragmatic breathing vs. vagus nerve stimulation in the treatment of fibromyalgia—A randomized controlled trial: Body vs. machine

Abstract

ImportanceVagus nerve innervation via electrical stimulation and meditative-based diaphragmatic breathing may be promising treatment avenues for fibromyalgia.ObjectiveExplore and compare the treatment effectiveness of active and sham transcutaneous vagus nerve stimulation (tVNS) and meditative-based diaphragmatic breathing (MDB) for fibromyalgia.DesignParticipants enrolled from March 2019–October 2020 and randomly assigned to active tVNS (n = 28), sham tVNS (n = 29), active MDB (n = 29), or sham MDB (n = 30). Treatments were self-delivered at home for 15 min/morning and 15 min/evening for 14 days. Follow-up was at 2 weeks.SettingOutpatient pain clinic in Oslo, Norway.Participants116 adults aged 18–65 years with severe fibromyalgia were consecutively enrolled and randomized. 86 participants (74%) had an 80% treatment adherence and 107 (92%) completed the study at 2 weeks; 1 participant dropped out due to adverse effects from active tVNS.InterventionsActive tVNS is placed on the cymba conchae of the left ear; sham tVNS is placed on the left earlobe. Active MDB trains users in nondirective meditation with deep breathing; sham MDB trains users in open-awareness meditation with paced breathing.Main outcomes and measuresPrimary outcome was change from baseline in ultra short-term photoplethysmography-measured cardiac-vagal heart rate variability at 2 weeks. Prior to trial launch, we hypothesized that (1) those randomized to active MDB or active tVNS would display greater increases in heart rate variability compared to those randomized to sham MDB or sham tVNS after 2-weeks; (2) a change in heart rate variability would be correlated with a change in self-reported average pain intensity; and (3) active treatments would outperform sham treatments on all pain-related secondary outcome measures.ResultsNo significant across-group changes in heart rate variability were found. Furthermore, no significant correlations were found between changes in heart rate variability and average pain intensity during treatment. Significant across group differences were found for overall FM severity yet were not found for average pain intensity.Conclusions and relevanceThese findings suggest that changes in cardiac-vagal heart rate variability when recorded with ultra short-term photoplethysmography in those with fibromyalgia may not be associated with treatment-specific changes in pain intensity. Further research should be conducted to evaluate potential changes in long-term cardiac-vagal heart rate variability in response to noninvasive vagus nerve innervation in those with fibromyalgia.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03180554, Identifier: NCT03180554.

Non-Invasive Electric and Magnetic Brain Stimulation for the Treatment of Fibromyalgia

“…Particularly, transcutaneous stimulation of the auricular and cervical branches of the vagal nerve induces modulatory effects on the activity of this nerve [ 86 , 87 ], with therapeutic impact in several pathologies [ 86 , 88 ]. Thus, the sympathetic and inflammatory dysregulation that appears to underlie fibromyalgia might be tackled non-invasively by tVNS [ 85 ], and some studies indeed suggest therapeutic effects of tVNS on pain and quality of life in patients with fibromyalgia [ 84 , 89 ].…”

Neuroimmunomodulation of vagus nerve stimulation and the therapeutic implications

“…taVNS improved overall fibromyalgia severity by clinical evaluation. However, there were no significant differences in the visual analog scale rated by patients or HRV compared with the sham group (Paccione et al, 2022 ). Wittbrodt et al ( 2021 ) recruited healthy participants with traumatic experiences and found that tcVNS increased anterior cingulate and hippocampal activity when exposed to trauma scripts.…”

“…VNS, vagus nerve stimulation; FDA, Food and Drug Administration; COVID-19, coronavirus disease 2019; ns, non-significant effect on study measure outcome. Reference number , 1 (Addorisio et al, 2019 ), 2 (Arsava et al, 2022 ), 3 (Badran et al, 2020 ), 4 (Chang et al, 2021 ), 5 (Courties et al, 2022 ), 6 (Dawson et al, 2021 ), 7 (De Ridder et al, 2015 ), 8 (Diener et al, 2019 ), 9 (Fisher et al, 2016 ), 10 (Garcia et al, 2021 ), 11 (Gaul et al, 2016 ), 12 (Gazi et al, 2022 ), 13 (Genovese et al, 2020 ), 14 (George et al, 2005 ), 15 (George et al, 2008 ), 16 (Goadsby et al, 2018 ), 17 (Gomolka et al, 2018 ), 18 (Grazzi et al, 2017 ), 19 (Kawai et al, 2017 ), 20 (Kozorosky et al, 2022 ), 21 (Kreuzer et al, 2014 ), 22 (Labar et al, 1999 ), 23 (Lange et al, 2011 ), 24 (Manning et al, 2019 ), 25 (Merchant et al, 2022 ), 26 (Mertens et al, 2022 ), 27 (Morris et al, 2013 ), 28 (Morris and Mueller, 1999 ), 29 (Muthulingam et al, 2021 ), 30 (Najib et al, 2022 ), 31 (Paccione et al, 2022 ), 32 (Redgrave et al, 2018 ), 33 (Rush et al, 2005a ), 34 (Rush et al, 2005b ), 35 (Salama et al, 2020 ), 36 (Shi et al, 2021 ), 37 (Silberstein et al, 2016a ), 38 (Silberstein et al, 2016b ), 39 (Stavrakis et al, 2020 ), 40 (Tassorelli et al, 2018 ), 41 (Tirado et al, 2022 ), 42 (Tornero et al, 2022 ), 43 (Tyler et al, 2017 ), 44 (Verrier et al, 2016 ), and 45 (Wittbrodt et al, 2021 ).…”

Research Progress of Acupuncture Analgesia Based on Autonomic Nerve Regulation Pathway

“…Animal and clinical studies suggest that myofascial pain syndrome induces sympathetic excitation, presenting with both local and referred pain [31][32] . In patients with fibromyalgia, parasympathetic excitation is reduced [33] ; however, vagus nerve stimulation has little benefit [34][35][36] . The use of anti-adrenergic drugs in patients with fibromyalgia can reduce excessive sympathetic nerve activity and the intensity of chronic pain [37] .…”