Neurostimulation via the vagus nerve


The Vagus nerve is the 10th cranial nerve. The nerve originates from the medulla of the brainstem, exiting the cranium via the jugular foramen.  Derived from the Latin word ‘vagary’ – meaning wandering - it is sometimes referred to as the “wandering nerve.” The vagus nerve extends from the head all the way to the abdomen.   


Sensations of touch, heat/cold, pain and chemical, metabolic, and hormonal operations of the organs is all transmitted via the vagus nerve to the brain. It effects the functioning of every system – from the immune to endocrine to the hormonal system – in our body.


There is growing evidence that vagal nerve stimulation (achieved via treatment with neurostimulation devices in practice), can deliver strong analgesic effects. Clinical indications of neurostimulation therapy for various chronic pain syndromes, including fibromyalgia, pelvic pain, and headaches have emerged in recent years.  While not an entirely new treatment methodology, neurostimulation has become more attractive in recent years in part due to factors that include:


•    Emergence of minimally invasive methods of application through innovation
•    Increased competition among device manufacturers resulting in greater cost efficiencies
•    Improving reimbursement environment
•    Tighter regulation of opioids and the growing risks to practitioners in the wake of the opioid addiction crisis.


Each of these factors has contributed to increasing patient demand for neurostimulation treatment.  Likewise, medical practitioners have found it to be a timely and effective alternative treatment option for mitigating risks and growing their practices. Through neurostimulation of the vagus, multiple areas can be modulated to alleviate pain, hence reducing the need for pharmacological interventions.


Within the cranium, the auricular branch of the vagus nerve supplies sensation to the posterior part of the external auditory and canal external ear.  The auricular branch provides access to the vagus in a way that enables noninvasive or minimally invasive neurostimulation techniques.  By introducing electrical impulses to the triangular fossa area of the ear, vagal nerve stimulation can be achieved without the surgical intervention required of earlier device types.  Indeed, recent studies have found noninvasive VNS appears to be as effective as the invasive counterpart for many indications1.


With an enormous potential therapeutic gain and a high safety profile, further development and application of noninvasive neurostimulation therapies is promising. Given increasing demand and contemporary concerns relating to opioid medications, practices should consider alternative pain treatment options to provide to patients.



1     Headache. 2017 Apr;57 Suppl 1:29-33. doi: 10.1111/head.12721. Epub 2015 Oct 16

 


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