Please explain these medical findings re: RA and vagus nerve stimulation

June 6, 2022 10:02 AM

I was reading a NYT article about how vagus nerve stimulation cures everything and vagus nerve snake oil etc. and thought to google vagus nerve stimulation rheumatoid arthritis and I came across this.. The problem is there's a lot here I don't understand. My questions are basically: Does this actually work sometimes? and (probably not from the article) Is this something one could (safely) try at home?

I don't know how to read those blood test results. Does it work? I take it that if it does work, it works for 57% of people who try it? How well does it work? And finally, if it works, could I somehow set my mom up to try it? Like it says auricular vagus nerve...google tells me that means ear...Is it possible and safe to set up a phone and earphones playing a sound at those hertz (don't laugh at me, this really isn't my area) or ... something? to give this a shot? Is there some other way to try it?

posted by If only I had a penguin... to Health & Fitness (7 answers total)

Best answer: Well, it's an uncontrolled, open-label study - everyone in the study got the treatment, so there's no comparison vs. an untreated group, and everyone in the study knew that they were getting this treatment. And the number of people in the study was very small, and the time during which they were studied was fairly short. Basically it's not a powerful study, and it can't really say much of anything - it's quite possible that a similar number of people would have had the same results with no treatment at all.

Also the research was funded by the maker of the device tested. (Which is true of most clinical trials.)

So, like, take it with a big grain of salt.
posted by mskyle at 10:19 AM on June 6, 2022 [4 favorites]

Best answer: The "stimulation" in this research you quoted involves sending electrical charges directly through the skin of the ear into a branch of the vagus nerve. It doesn't involves sending sound waves into the ear canal so an audio approach will not work.

Like mskyle says, this paper doesn't mean very much.
posted by JoeZydeco at 10:22 AM on June 6, 2022

Best answer: So, a few things to note: this study was funded (that's at the bottom of the page) by a company called Nesos, who makes the device in question (as mskyle noted). They are apparently a start up interested in brain hacks.

What I would suggest: are you in touch with your mom's doctor or is she pretty savvy? I would suggest forwarding this to her to share with her doctor to have a conversation. That would be a pretty good starting point. I know it's super temping to go down a rabbit hole here, but please do loop in her medical provider.
posted by bluedaisy at 10:23 AM on June 6, 2022

Another thing you could do: apparently they are working on getting some studies done in the US. (Are you in the US?) You could look at any research hospitals near your mom and see if they happen to be enrolling participants in any rheumatoid arthritis studies. Perhaps she would qualify.
posted by bluedaisy at 10:26 AM on June 6, 2022

Christopher Bergland has written about Vagus Nerve Stimulation in Psychology Today. I do it when I remember; I can't tell if it really helps with inflammation, but I think it reduces stress. You can do a gentle valsalva maneuver sitting in a chair. It's a good idea to chat with your doc about this. I have a fast heart rate and get tachycardia, these benefit from vagus nerve stimulation.

Low-key methods that don't use patentable meds or devices to improve health generally don't get studies done. Seems reasonable to try this cautiously.
posted by theora55 at 10:40 AM on June 6, 2022 [1 favorite]

As it says in the title, this is a proof of concept study. So they aren't setting out to prove that this therapy works or how effective it is, but more just to show that there is some possibility that it could work, that it probably isn't causing huge numbers of side effects and it probably isn't making a whole lot of people worse. They would also aim to learn more about the practicalities of studying the therapy before embarking on a large, expensive trial. So this study wasn't designed to tell us if the therapy actually works and thus isn't appropriate to guide treatment — because we don't know if it works!

So basically, it's a matter of waiting for results from an actual randomized, controlled study (though I hope they are setting up a good sham treatment for the control group, because there could be a significant placebo effect) or, as bluedaisy says, enrolling in the studies.
posted by ssg at 11:40 AM on June 6, 2022

When done right, vagus nerve stimulation inhibits inflammation. This makes it a promising research area for the approximately forty bazillion illnesses where inflammation makes up a major part. (RA being one.). If you go to pubmed and look up "vagus stimulation" and "rheumatoid arthritis" you'll see several pilot studies into vagus stimulation for RA, not all sponsored by device companies, and they all have promising results -- but they're all still preliminary in nature.

In the meantime, it seems worthwhile to highlight a comment on that same NYT article from Lauren Stiles, who is an assistant neurology prof and the president of Dysautonomia International (an activism group for an illness which involves vagus dysfunction):

"There are multiple FDA and CE (European Commission) approved vagus nerve stimulation devices like IB Stim, Gammacore, and NEMOS. There is peer-reviewed evidence that TENS units, long popular for muscle pain relief, can be used to stimulate the auricular branch of the vagus nerve. There is also peer-reviewed evidence demonstrating that regular exercise, good sleep, Vitamin D, fish oil, and medications like anti-histamines and pyridostigmine can stimulate the vagus nerve. These methods are all much more accessible than expensive neurosurgery. I'd love to see a follow up article on evidence based non-surgical approaches to vagus nerve stimulation."

I would strongly recommend against trying electrical stimulation without the assistance of a health professional, since it's experimental and -- if done wrong -- potentially damaging. But maybe your mom could talk to her doc about some of the things that Lauren Stiles mentions above. Best of luck!
posted by hungrytiger at 4:43 PM on June 6, 2022 [1 favorite]