Research Progress of Transcutaneous Auricular Vagus Nerve Stimulation in Chronic Pain Management: A Narrative Review

Chronic pain represents a significant global public health burden, affecting millions of individuals and substantially impairing quality of life. However, its clinical management is largely limited by the modest efficacy and considerable adverse effects of current pharmacological interventions, highlighting an urgent need for safe and effective non-pharmacological alternatives. Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive neuromodulation technique, has emerged as a promising therapeutic strategy. By multitarget neurotransmitter modulation, activating the cholinergic anti-inflammatory pathway (CAP), rebalancing autonomic function, and remodeling central pain networks, taVNS has produced emerging but heterogeneous clinical evidence for pain relief, while most trials have reported that the intervention is generally well-tolerated, which has drawn growing research attention. This narrative review provides a comprehensive, clinically oriented overview of taVNS in chronic pain management, integrating mechanistic insights from preclinical and human studies, appraising the breadth and limitations of existing clinical evidence across pain phenotypes, and delineating key translational barriers. Future directions are proposed to guide both research priorities and clinical decision-making.