AUTHOR=Paccione Charles Ethan , Stubhaug Audun , Diep Lien My , Rosseland Leiv Arne , Jacobsen Henrik Børsting TITLE=Meditative-based diaphragmatic breathing vs. vagus nerve stimulation in the treatment of fibromyalgia—A randomized controlled trial: Body vs. machine JOURNAL=Frontiers in Neurology VOLUME=Volume 13 - 2022 YEAR=2022 URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1030927 DOI=10.3389/fneur.2022.1030927 ISSN=1664-2295 ABSTRACT=Importance Vagus nerve innervation via electrical stimulation and meditative-based diaphragmatic breathing may be promising treatment avenues for fibromyalgia. Objective Explore and compare the treatment effectiveness of active and sham transcutaneous vagus nerve stimulation (tVNS) and meditative-based diaphragmatic breathing (MDB) for fibromyalgia. Design Participants enrolled from March 2019 – October 2020 and randomly assigned to active tVNS (n = 28), sham tVNS (n = 29), active MDB (n = 29), or sham MDB (n = 30). Treatments were self-delivered at home for 15 min/morning and 15 min/evening for 14 days. Follow-up was at 2 weeks. Setting Outpatient pain clinic in Oslo, Norway. Participants 116 adults aged 18 – 65 years with severe fibromyalgia were consecutively enrolled and randomized. 86 participants (74%) had an 80% treatment adherence and 107 (92%) completed the study at 2 weeks; 1 participant dropped out due to adverse effects from active tVNS. Interventions Active tVNS is placed on the cymba conchae of the left ear; sham tVNS is placed on the left earlobe. Active MDB trains users in nondirective meditation with deep breathing; sham MDB trains users in open-awareness meditation with paced breathing. Main Outcomes and Measures Primary outcome was change from baseline in cardiac-vagal heart rate variability at 2 weeks. Prior to trial launch, we hypothesized that 1) those randomized to active MDB or active tVNS would display greater increases in heart rate variability compared to those randomized to sham MDB or sham tVNS after 2-weeks; 2) a change in heart rate variability would be correlated with a change in self-reported average pain intensity; and 3) active treatments would outperform sham treatments on all pain-related secondary outcome measures. Results No significant across-group changes in heart rate variability were found. Furthermore, no significant correlations were found between changes in heart rate variability and average pain intensity during treatment. Significant across group differences were found for overall FM severity yet were not found for average pain intensity. Conclusions and Relevance These findings suggest that cardiac-vagal heart rate variability may not be associated with treatment-specific changes in pain intensity in those with fibromyalgia. Trial Registration Clinicaltrials.gov Identifier: NCT03180554 https://clinicaltrials.gov/ct2/show/NCT03180554