Abstract for NANS meeting. TAVNS and Autonomic Balance in the Acupuncture Clinic: Clinical Case Study

This is my abstract for the upcoming NANS conference in NYC.  It was accepted!  So to NYC for me in August.

Introduction: Improving autonomic balance (increasing parasympathetic activity and decreasing sympathetic activity)leads to better immunity, pain tolerance, mood, longevity and inflammation. Both Transcutaneous Auricular Vagal Nerve Stimulation (TAVNS)[i] and acupuncture[ii] [iii] [iv]have been shown to non-invasively improve autonomic balance. TAVNS has been shown to decrease sympathetic activity within 2 minutes of application[v], but also to improve autonomic balance over days and weeks[vi], as with acupuncture. But acupuncture can be relatively expensive and can require weekly clinic visits.  To enhance and prolong acupuncture’s clinical effect with a home treatment such as TAVNS would be more economical and convenient.  Ensuring safety as well as determining best stimulation parameters would be a significant first step in establishing this protocol.

The author incorporates Heart Rate Variability(HRV) monitoring in conjunction with acupuncture to evaluate autonomic response before, during and after needling. The data also documents autonomic balance over weeks to months. Published acupuncture protocols are used that demonstrate improved autonomic balance combined with traditional acupuncture treatment.

TAVNS was added to acupuncture sessions to assess the autonomic response compared with acupuncture alone.  Medical conditions of hypertension, migraine or anxiety/panic are all characterized by some autonomic dysfunction.  A group of patients with these disorders are considered here for study.

Methods: All patients included in this report had positive clinical results, i.e. resolution of migraines and anxiety, or reduction in blood pressure. Heart rate(HR) was monitored with a Nonin Pulse oximeter during baseline, needling and rest for a total time of 30 minutes. HR tracing was then analyzed for HRV using Vivosense software. TAVNS protocol used TAVNS stimulation parameters from previous studies[vii] and a novel TAVNS protocol using alternating stimulation between the right and left ear. TAVNS was applied with ear clip electrodes in the cymba concha region, at 25 or 1 hz. HRV from TAVNS sessions plus acupuncture was compared to acupuncture sessions alone.

Results: TAVNS was well tolerated in the clinic with no arrhythmias, syncope, or artifact introduced. In a few cases it lead to an improvement in autonomic balance compared to acupuncture alone, but in general there was no additional improvement. Details of autonomic response to treatment will be discussed.

Conclusion: TAVNS appears to be a safe addition to acupuncture treatment for conditions characterized by autonomic dysfunction.  Refining the TAVNS protocol (frequency, timing and patient selection) may improve results. Documenting improvement of autonomic balance over time would be of particular clinical importance.

[i] Clancy JA, Mary DA, Witte KK, et.al Non-invasive vagus nerve stimulation in healthy humans reduces sympathetic nerve activity. Brain Stimul. 2014 Nov-Dec;7(6):871-7.

[ii] Mehta PK, Polk DM, Zhang X, et.al. A randomized controlled trial of acupuncture in stable ischemic heart disease patients. .Int J Cardiol. 2014 Sep 20;176(2):367-74.

[iii]Bäcker M, Grossman P, Schneider J, et al. Acupuncture in migraine: investigation of autonomic effects.  Clin J Pain 2008 Feb;24(2):106-15.

[iv] Beissner F1, Deichmann R, Henke C, Bär KJ. Neuroimage. 2012 Mar;60(1):653-60.Acupuncture–deep pain with an autonomic dimension?

[v] Conf Proc IEEE Eng Med Biol Soc. 2017 Jul;2017:3130-3133.

Respiratory-gated Auricular Vagal Afferent Nerve Stimulation (RAVANS) effects on autonomic outflow in hypertension.

Sclocco R, Garcia RG, Gabriel A, Kettner NW, Napadow V, Barbieri R.

[vi] Front Med (Lausanne). 2017; 4: 124. Non-invasive Vagal Nerve Stimulation Effects on Hyperarousal and Autonomic State in Patients with Posttraumatic Stress Disorder and History of Mild Traumatic Brain Injury: Preliminary Evidence

Damon G. Lamb,^1,2,3,4 Eric C. Porges,^2,4 Greg F. Lewis,^5,6,7 and John B. Williamson^1,2,3,4,*

[vii] Brain Stimulation March–April, 2017Volume 10, Issue 2, Page 378 B.W. Badran

, C.E. Glusman, A.W. Badran, C.W. Austelle, W.H. DeVries, J.J. Borckhardt, M.S. George.

The physiological and neurobiological effects of transcutaneous auricular vagus nerve stimulation (taVNS)