523: Efficacy of Transcutaneous Auricular Vagus Nerve Stimulation for Postherpetic Neuralgia

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Neuromodulation (e.g. TMS, TDCS, FUS, SCS, MCS, DBS, vagus nerve stimulation)

Background and Aims: Postherpetic neuralgia (PHN) is a prevalent and debilitating complication of herpes zoster, characterized by persistent neuropathic pain that often proves refractory to conventional pharmacotherapy, representing a significant clinical management challenge. Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive neuromodulatory intervention, has emerged as a promising approach due to its analgesic and anti-inflammatory mechanisms. This randomized controlled study aimed to evaluate the specific efficacy and safety of taVNS versus in alleviating pain and improving sleep in patients with PHN over a 12-week follow-up period.

Methods: A total of 114 eligible patients diagnosed with PHN were randomly allocated into two groups (n=57 ). The intervention group received taVNS targeting the left cavum conchae, The control group received sham stimulation at the left earlobe. Both groups completed one-hour stimulation sessions daily for seven consecutive days. The primary efficacy endpoint was the treatment response rate at the 12-week post-treatment assessment. Secondary outcomes, measured at baseline and weeks 1, 2, 4, 8, and 12, included pain intensity assessed via the Numerical Rating Scale (NRS) and sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI).

Results: The treatment response rate at 12 weeks was statistically significantly higher in the taVNS group compared to the control group. Analysis of secondary outcomes revealed that from week 2 through week 12, the taVNS group exhibited significantly greater reductions in both mean NRS pain scores and PSQI scores than the control group (p<0.05). No significant between-group differences were observed at the week 1 assessment. The intervention was well-tolerated, with no serious adverse events reported in either group.

Conclusions: taVNS is significantly in reducing pain and enhancing sleep quality in patients with PHN, with effects sustained for at least 12 weeks. These findings demonstrate that taVNS is an effective, safe, and well-tolerated non-invasive therapy, supporting its integration into clinical practice for PHN management.

References: Chen Y, et al. Efficacy and mechanism of transcutaneous auricular vagus nerve stimulation for complementary treatment of postherpetic neuralgia. Chin J Painol. 2020.

Rong P, et al. Transcutaneous Auricular Vagus Nerve Stimulation for Chronic Insomnia: A Randomized Clinical Trial. JAMA Netw Open. 2024.

de Sousa GAG, et al. Effects of multisession prefrontal cortex tDCS or taVNS on stress and sleep quality: a double-blind study. Front Psychol. 2024.

Liu Q, et al. Effect of paraspinal nerve block combined with taVNS on acute herpes zoster patients. Chin J Pain Med. 2023.

Presenting Author: Hua Zhang
Submitting Author: BO WANG

Senior Author: Bo Wang

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Jian-Ming Yu: Dr - Department of Anesthesiology and Pain Medicine, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China
• Hua Zhang: Dr - Department of Anesthesiology and Pain Medicine, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China