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However, its role in fibromyalgia (FM) remains insufficiently explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether stimulation laterality (left vs right auricular branch of the vagus nerve) differentially influences clinical and biological outcomes in women with FM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomized, double-blind, sham-controlled trial, 51 women with FM were allocated to sham stimulation, right-sided aVNS (aVNS-R), or left-sided aVNS (aVNS-L). Participants underwent weekly sessions for 4\u00a0weeks and were followed for 12\u2009weeks. Pain intensity was the primary outcome. Secondary outcomes included psychological symptoms, sleep, functional status, quality of life, and circulating biomarkers (pro- and anti-inflammatory cytokines, brain-derived neurotrophic factor [BDNF]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>While no significant between-group differences were observed in pain intensity, left-sided stimulation (aVNS-L) was associated with a modest but significant reduction in global symptom severity. Importantly, aVNS-L produced consistent immunomodulatory effects, including decreased IL-1\u03b2 and TNF-\u03b1 levels, and increased IL-4, IL-10, and BDNF concentrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This exploratory trial suggests that stimulation laterality may shape the biological response to aVNS in FM. Although clinical pain relief was not superior to sham, left-sided stimulation promoted an anti-inflammatory profile and enhanced neuroplasticity markers. These findings support further investigation of aVNS laterality as a targeted neuromodulatory approach for FM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Brazilian Clinical Trials Registry RBR-10d3crcf.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pm\/pnag013","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:11:09Z","timestamp":1769515869000},"page":"804-813","source":"Crossref","is-referenced-by-count":1,"title":["Laterality-dependent biological effects of manual acupuncture stimulation of the auricular vagus nerve in women with fibromyalgia: a randomized, sham-controlled trial"],"prefix":"10.1093","volume":"27","author":[{"given":"Marcos Lisboa","family":"Neves","sequence":"first","affiliation":[{"name":"Program of Post-graduation in Neuroscience, Universidade Federal de Santa Catarina (UFSC) , 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dos Santos","family":"Bud","sequence":"additional","affiliation":[{"name":"Program of Post-graduation in Neuroscience, Universidade Federal de Santa Catarina (UFSC) , Florian\u00f3polis, Santa Catarina,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Merian","family":"Da Silva","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Pharmacology, Universidade Federal de Santa Catarina , Florian\u00f3polis, Santa Catarina,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vin\u00edcius Alexandre","family":"Wippel","sequence":"additional","affiliation":[{"name":"Program of Post-graduation in Neuroscience, Universidade Federal de Santa Catarina (UFSC) , Florian\u00f3polis, Santa Catarina,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor Kunze","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Hospital Regional de S\u00e3o Jos\u00e9 Dr. Homero 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