Auricular Percutaneous Electrical Nerve Field Stimulation in Disorders of Gut–Brain Interaction: A Clinician’s Approach

Abstract

Chronic abdominal pain, chronic nausea and autonomic symptoms are common, debilitating complaints in children and young adults with disorders of gut–brain interaction (DGBI)¹. Despite a broad range of pharmacologic and behavioral therapies, many patients experience incomplete relief or medication-related side effects, underscoring a major unmet need for safe, non-pharmacologic neuromodulatory treatments.^1,2

Auricular percutaneous electrical nerve field stimulation (PENFS), delivered via a small wearable device placed behind the ear represents an emerging, minimally invasive neuromodulation strategy aimed at modulating central autonomic and visceral pain pathways.³ By stimulating afferent auricular branches of the cranial nerves supplying the gastrointestinal (GI) tract, predominantly the vagus nerve, this therapy seeks to rebalance dysregulated gut–brain signaling implicated in nausea, visceral hypersensitivity, and autonomic dysfunction.⁴

This article outlines the physiologic rationale for auricular PENFS, available devices, predicted effectiveness across relevant clinical conditions, and a practical approach to patient selection, treatment implementation, and monitoring in clinical practice.