Chronic central-origin pain in pediatric patients requires a multidisciplinary approach addressing altered pain processing, autonomic dysregulation, and psychosocial factors. Vagal neuromodulation, particularly transcutaneous auricular vagus nerve stimulation, represents a promising noninvasive strategy for modulating pain related pathways. This article reviews its underlying mechanisms, potential clinical applications, and current limitations, alongside the possible role of neuroendocrine, neurotransmitter- related, and gut microbiota assessments. Although biologically plausible, clinical evidence in children remains limited. Further controlled trials, standardized stimulation protocols, and validated biomarkers are needed to establish its safety, efficacy, and role in individualized pediatric chronic pain management.

Keywords: Chronic Central-Origin Pain; Pediatric Patients; Vagal Neuromodulation; Transcutaneous Vagus Nerve Stimulation (tVNS)

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