Impaired Vagal Regulation May Predict Pain Response to Stimulation Therapy in Pediatric Functional Abdominal Pain Disorders

Impaired vagal regulation can predict adolescents’ pain response to percutaneous electrical nerve field stimulation (PENFS) therapy, according to findings from a study presented at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) Annual Meeting and Postgraduate Course.

The researchers preliminary data suggested that PENFS may modulate vagal regulation.

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To determine whether baseline vagal efficiency (VE) could predict pain response, the researchers randomly assigned 115 adolescents aged 11 to 18 years to active or sham PENFS therapy. All adolescents met Rome III diagnostic criteria for at least one functional abdominal pain disorder.

All patients in the active treatment group received 3.2 V of PENFS therapy with alternating stimulation frequencies from 1 to 10 Hz for 5 days per week for 4 consecutive weeks. The sham device used in the sham group was identical but had no electrical charge.

The researchers measured heart rate variability among a subset of patients before and after 3 weeks of therapy and 8 to 12 weeks after therapy ended.

Baseline data on VE was available for 45 patients in the active PENFS treatment group and 45 patients in the sham group. Patients in the active PENFS treatment group and sham group had similar levels of predicted pain at preassessment.

The researchers observed a 3-way interaction of VE among the active PENFS treatment group with the week 3 time-point compared with the preassessment time point. The interaction indicated that patients in the active PENFS treatment group with low VE had reduced Composite Pain scores at the 3-week time point, but there was no significant change among those with high VE or among those in the sham group.

Additionally, the researchers did not observe a significant interaction at postassessment.

“These unique findings are suggestive of vagal nerve modulation effects of PENFS in adolescents with [functional abdominal pain disorders],” the authors concluded. “The VE measure may be an essential tool to predict therapeutic response to PENFS.”

—Melinda Stevens

Reference:

Kovacic K, Kolacz J, Porges S. Impaired vagal efficiency predicts pain reduction with percutaneous electrical nerve field stimulation (PENFS) therapy for functional abdominal pain disorders [abstract 217]. Presented at: NASPGHAN Annual Meeting and Postgraduate Course; October 17-19, 2019; Chicago, IL.

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