Grand Rounds: Neuromodulation in Tune with the Body’s Rhythms: Enhancing Clinical Outcomes with Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation (RAVANS)

Event Date: September 10th, 2019

Vitaly Napadow, PhD, LicAc

Grand Rounds: Neuromodulation in Tune with the Body’s Rhythms: Enhancing Clinical Outcomes with Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation (RAVANS)

The rhythm of the breath is fundamental. Breathing is controlled by both autonomic and volitional processes – we don’t need to think about breathing in order to breathe, but we can also significantly speed up or slow down our respiratory rate. Conversely, the respiratory rhythm can itself impact cognitive, emotional, and sensory processing via inhibitory and facilitory connections from the respiration central pattern generator, the Ventral Respiratory Group, in the medulla of the brainstem.

Furthermore, transcutaneous vagus nerve stimulation (tVNS) is a promising therapy for several visceral and brain disorders such as migraine, depression, and visceral pain. As the primary afferent relay for the vagus nerve lies in the medulla and is differentially influenced by different phases of the respiratory rhythm, we have proposed that Respiratory-Gated Vagal Afferent Nerve Stimulation (RAVANS) can enhance brainstem targeting, leading to enhanced clinical outcomes. This concept may also underlie theories of respiration rhythm influence on acupuncture needle insertion and stimulation, as evidenced in traditional Chinese medicine texts.

This talk will explore the known and unknown in the links between respiratory rhythm and vagus nerve physiology and clinically-applied stimulation.


Vitaly Napadow is an Associate Professor at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital and Harvard Medical School in Boston, MA, where he is also the Director of the Center for Integrative Pain Neuroimaging (CiPNI).  Vitaly also holds a secondary appointment at the Pain Management Center at Brigham and Women’s Hospital, where he practices acupuncture. He received his Ph.D. in biomedical engineering from the Harvard-MIT Health Sciences and Technology program.

Dr. Napadow’s laboratory has pioneered the application of non-invasive neuroimaging techniques to better understand the brain circuitry underlying aversive perceptual states, particularly chronic pain, and to better understand how non-pharmacological therapies ameliorate these states. Specifically, somatosensory, cognitive, and affective factors all influence the malleable experience of pain, and Vitaly’s Lab has applied human functional and structural neuroimaging to localize and suggest mechanisms by which different brain circuitries modulate pain perception. Dr. Napadow has more than 130 publications in leading peer-reviewed scientific journals and serves on numerous conference, journal, and NIH review panels.

Speaker Resources

Napadow, V., R. R. Edwards, C. M. Cahalan, G. Mensing, S. Greenbaum, A. Valovska, A. Li, J. Kim, Y. Maeda, K. Park and A. D. Wasan (2012). “Evoked pain analgesia in chronic pelvic pain patients using respiratory-gated auricular vagal afferent nerve stimulation.Pain Med 13(6): 777-789.

Garcia, R. G., R. L. Lin, J. Lee, J. Kim, R. Barbieri, R. Sclocco, A. D. Wasan, R. R. Edwards, B. R. Rosen, N. Hadjikhani and V. Napadow (2017). “Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients.” Pain 158(8): 1461-1472.

Event Details

Date: Tuesday, September 10*, 2019
*NOTE: Off-calendar scheduling: This Grand Rounds presentation, originally scheduled for February, 2019, takes place on the 2nd Tuesday of September.

Time: 8:00 am – 9:00 am (followed by Coffee Hour)
Venue: Bornstein Family Amphitheater, BWH
Address: 45 Francis Street, Boston, MA 02115

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