Current applications of transauricular vagus nerve stimulation in orthopedics: a narrative review of the literature.

Objectives: Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique with emerging applications in various medical fields. While its role has been explored in neurological, psychiatric, and inflammatory conditions, its potential in orthopedics has not been reviewed in depth. Our objective was to synthesize current evidence on the use of taVNS in orthopedic conditions. Methods: A PubMed search was conducted for articles published between January 2010 and July 2025 using the terms "transcutaneous" AND "vagus nerve" AND "stimulation." Seventeen eligible studies were identified after applying predefined inclusion and exclusion criteria. Randomized controlled trials were assessed for methodological quality using the Risk of Bias 2 tool. Results: Seventeen studies addressed the orthopedic applications of taVNS for chronic low back pain, neck pain, knee osteoarthritis, and in perioperative settings. Across the included studies, taVNS was associated with reductions in pain intensity, although superiority over control interventions was not consistent across trials; additional potential benefits were reported for sleep quality, disability indices, and psychological measures. In perioperative contexts, high-quality randomized trials demonstrated reductions in postoperative pain and analgesic requirements. However, methodological heterogeneity, small sample sizes, and inconsistent stimulation protocols limit the strength of the conclusions. Discussion: taVNS is a safe, accessible, and promising adjunctive therapy for pain management in orthopedics, with potential applications in both chronic and perioperative settings. Larger, high-quality trials are required to establish standardized protocols and clarify clinical efficacy.