Conference Paper

Analgesic Self-Medication and Heart Rate Variability - A Preliminary Investigation

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Background: Recently, we provided first evidence for altered autonomic nervous system (ANS) function indexed by reduced heart rate variability (HRV) in the presence of of pain in apparently healthy subjects. Self-medication with analgesics is common among individuals that experience pain. Such reports might therefore provide further information on the severity of reported pain symptoms and individual coping strategies. Within the present analysis we aimed to investigate the relation of analgesic self medication and HRV. Methods: Pain symptoms were assessed using the 4 pain related items from the symptom checklist (SCL-90r). Participants were asked to rate the frequency of analgesic self medication for all available pain killers on four categories: never (0), once (1), sometimes (2), or on a regular base (3). For further analysis a dichotomized variable for each medication (no to barely and sometimes to regular intake) was generated and subjects were stratified to groups. HRV was measured for 5 minutes in a supine position using a portable device to record inter-beat-intervals at a sampling frequency of 1000 Hz. The root mean square of successive differences (RMSSD) – a vagally mediated measure of HRV – was derived and log transformed for further analysis. Multiple linear regression analysis adjusting for age, sex, body weight and height was used to assess the relation of analgesic intake to HRV. Results: A total of 58 participants completed the trial. Time to time intake was reported most frequently for Ibuprofen (44.8%), Aspirin (31.0%), and Voltaren (24.1%). The frequency of Ibuprofen intake was associated with the presence of headaches (r = .460, p < .001). The log transformed population average of RMSSD was 3.99±0.69 ms. Subjects that frequently used Ibuprofen had significantly lower log RMSSD (F(1;51) = 13.136, p < .001) compared to subjects that did not or barely use it. Linear regression results indicate a significant decrease in log RMSSD in participants indicating to use Ibuprofen sometimes or regularly. All other variables were not associated with RMSSD. Explained variance was 23% Conclusion: This is the first study to show that subjects that frequently use Ibuprofen for analgesic self medication have lower vagal activity. These findings are likely moderated by the presence of pain, since self-medication correlated with the presence of headaches. However, in line with our previous reports on reduced HRV in subjects with pain, we provide further evidence using a different methodological approach. Future studies should investigate the impact of coping style on this association.

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... Pharmaceutical analgesic self-medication is common and broadly accepted in individuals that experience pain. Recently, we found an association of ibuprofen use and HRV in a small sample of subjects [17]. This article aims to further explore the association of pain interference, analgesic self-medication, and HRV in a large cross-sectional sample of 4,742 individuals. ...
... Individuals that reported greater pain interference within the last 4 weeks had lower RMSSD. A similar association was observed for vmHRV and the frequency of analgesic intake, as previously suggested by preliminary findings [17]. Again, individuals that reported frequent use of analgesics had lower RMSSD. ...
Objective Persistent pain is associated with dysfunction of the autonomic nervous system, in particular a loss of vagal inhibitory control, that can be indexed by decreased vagally mediated heart rate variability (vmHRV). Effective treatment (e.g., analgesic self-medication) may lead to a restoration of vmHRV. The objective of this article was to further explore the relationship of pain and vagal control and to investigate the effect of analgesic self-medication on the association of vmHRV and pain.Methods We used a large cross-sectional data set on pain ratings and analgesic intake from the Mannheim Industrial Cohort Study for secondary analysis. The root mean square of successive differences, a measure of vmHRV corresponding to the parasympathetic regulation of the heart, was derived from 24-hour electrocardiogram recordings.ResultsThe frequency of analgesic intake and interference of pain are significantly associated. Individuals that report greater pain interference with their normal work routine (including both work outside the home and housework) and frequent analgesic intake have significantly lower vmHRV. Subjects with ineffective analgesic intake (reporting great pain interference and high frequent analgesic intake) had the lowest vmHRV. Individuals effectively taking analgesics (reporting no or low pain interference and high frequent analgesic intake) showed greater vmHRV compared to those ineffectively taking. Analysis revealed significant differences and linear trends on vmHRV between all groups.Conclusion In line with previous research, vmHRV is inversely associated with pain interference. Analgesic intake mediates the association of vmHRV and pain. Effective analgesic self-medication may lead to a restoration in vmHRV. These results further support the vagus nerve as an objective indication of pain severity and treatment efficacy in patients with persistent pain.
... Our findings highlight that nonsteroidal anti-inflammatory drugs (NSAIDs) seem to be connected to the sympathetic component, as evidenced by reductions in HR and the SNS index. Our results, however, do not allow us to reach any conclusion because of the small number of subjects taking these medications [38][39][40]. ...
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Heart rate variability (HRV) is a simple, non-invasive, real-time analyzable, and highly reproducible measurement that captures incidences for assessing a person’s health and physical condition. Public security jobs are characterized by major exposure to risk factors known to influence the cardiovascular response to stimuli, e.g., night shifts, highly physically demanding activity, and acute stress activity. This study aimed to evaluate the HRV parameters in a population of 112 male personnel of the special forces and public order of the Carabinieri, aged 25–59, when engaged in several duty tasks, such as paratroopers, night shift police station officers, night shift patrol, dynamic precision shooting evaluative team, dynamic precision shooting non-evaluative team, and office clerks (used as control group). During the specific task of each participant, the HRV parameters were collected with wearable devices and processed. The HRV parameters in the time and frequency domains collected were average heart rate, standard deviation of all normal RR intervals, root mean square of successive differences in adjacent normal-to-normal (NN) intervals, very-low-frequency power, low-frequency power, high-frequency power, stress index, parasympathetic nervous system activity index, and sympathetic nervous system activity index. Parametric tests for independent series to compare the HRV parameters by subgroups within the study subjects were used. A multivariate linear regression analysis was conducted to evaluate the association between the HRV parameters and some personal and organizational factors. The comparison between different subgroups showed that activities with a high demand for concentration and precision, as is the case with paratroopers and dynamic precision shooters, differ significantly from activities that can be defined as routine, such as office work. Other activities, such as patrolling or remote management from operations centers, although including critical elements, did not deviate significantly from the control group. The study of HRV parameters is therefore a useful tool for occupational physicians, both for addressing work suitability assessments and for better targeting health promotion campaigns, to be considered as being aimed at monitoring the subject’s physiological parameters, and not at the diagnosis of any pathological condition, which should always be carried out by the medical specialist.
The aim was to evaluate differences in the autonomic nervous system (ANS) activity, indexed by heart rate variability (HRV) in apparently healthy subjects with self-reported symptoms of pain (SRSP) within an exploratory analysis. HRV data from 14 apparently healthy male individuals were analyzed to address potential differences in subjects with and without SRSP. SRSP was assessed using the four pain-related items from the symptom checklist (SCL-90R). Subjects were stratified based on the presence of SRSP. Parasympathetic activity, indexed by pNN50, RMSSD, and high frequency (HF) spectrum of HRV, was lower in subjects with SRSP. Low frequency (LF) HRV and the LF/HF ratio were greater in subjects with SRSP. However, analysis of variance revealed no significant differences between the groups. Pearson correlations showed a correlation of pNN50, HF, LF, and LF/HF ratio and the presence and frequency of SRSP. Measures of parasympathetic activity (pNN50 and HF) were inversely associated with more SRSP, indicating that subjects with more frequent SRSP show decreased parasympathetic activity. Consistent with evidence on changes in HRV in patients with clinical conditions of chronic or recurrent pain, this is the first study to show that healthy individuals who report symptoms of pain may have lower parasympathetic activity revealed by measures of HRV.
Conference Paper
Background: A large variety of health conditions is associated with changes in autonomic nervous system (ANS) function that can be indexed by alterations in heart rate variability (HRV). Reduced HRV is reported in patients with chronic pain such as complex regional pain syndrome or fibromyalgia. Recently, we provided first evidence for reduced HRV in the presence of self-reported symptoms of pain also in apparently healthy subjects. However, it is not clear whether these changes correlate with the frequency or intensity of the reported symptoms. Methods: The Quick Inventory of Pain Symptoms (QIPS) was used to assess the frequency and intensity of pain symptoms in the most common locations within the last week. A total pain index (TPI100), a pain intensity index (PII100), and a pain frequency index (PFI100) were calculated from the inventory. HRV was measured for 5 minutes in a supine position using a portable device to record inter-beat-intervals (IBI) at a sampling frequency of 1000 Hz. Device-specific software was used to transfer recordings for further analysis with “Kubios HRV”. The low frequency (LF) and high frequency power spectrum (HF) were derived by use of autoregressive models. Results: Data from a total of 67 (40 female, mean age 23.1±4.2 years) subjects was available for analysis. 49 subjects reported at least one pain symptom (most frequently headaches 61.2%) compared to 18 subjects free of pain. ANOVA revealed significant differences on HF (F(1, 59)=8.228, p = .006) and LF (F(1, 59)=8.230, p = .006) and the LF/HF ratio (F(1, 59)=6.965, p = .011) between subjects with pain and pain free subjects. The LF/HF ratio was significantly and positively correlated with the location scores for shoulder/neck pain (r = .412, p < .001) and low back pain (r = .407, p < .001) but not with headaches, chest pain or muscle pain in general. Furthermore, the LF/HF ratio was associated with the TPI100 (r = .383, p = .002) and the PII100 (r = .266, p = .032). The observed trend in the positive correlation between LF/HF ratio and pain frequency index missed statistical significance (TPF: r = .235, p = .057). Conclusion: In line with previous research, our results reveal differences on ANS function in subjects reporting pain and participants free of pain. Furthermore, we extend previous findings and provide first evidence for a unique association that alterations of ANS function due to the presence of pain are more likely driven by the experienced pain intensity than the frequency of symptoms. Greater pain intensity is associated with a shift towards lower vagal activity indexed by HF power of HRV in non-clinical subjects.
Alterations of Autonomic Nervous System Function due to the Presence of Pain –Is it Symptom Frequency or Intensity?. Poster presented at the American Psychosomatic Society (APS), 72nd Annual Scientific Meeting a copy can be requested via researchgate or quantifiedpain
  • J Koenig
  • Mn Jarczok
  • M Warth
  • Tk Hillecke
  • Jf Thayer
Koenig J, Jarczok MN, Warth M, Hillecke TK, Thayer JF. Alterations of Autonomic Nervous System Function due to the Presence of Pain –Is it Symptom Frequency or Intensity?. Poster presented at the American Psychosomatic Society (APS), 72nd Annual Scientific Meeting a copy can be requested via researchgate or 1307