Vagus nerve stimulation in musculoskeletal diseases

The vagus nerve is the main of parasympathetic autonomic nervous system. Beyond its vegetative functions, possesses anti-inflammatory and analgesic properties. Initially developed in treatment refractory epilepsy, stimulation (VNS) currently being evaluated several musculoskeletal diseases. VNS can be invasive by placing an electrode around cervical connected to a generator implanted subcutaneously or non-invasive stimulating branch percutaneously (auricular cervical). In rheumatoid arthritis (RA) patients, has been shown dampen inflammatory response circulatory peripheral cells. Several open-labeled small pilot studies have demonstrated that VNS, either transcutaneous, associated with significant decrease RA disease activity. As well, other could limit fatigue Sjogren's syndrome systemic lupus, pain fibromyalgia as well erosive hand osteoarthritis. However, some questions remain, such settings stimulation, duration treatment, optimal route. Finally, randomized controlled trials versus sham large samples patients are mandatory definitively conclude about efficacy VNS.