Article

Pneumogastric (Vagus) Nerve Activity Indexed by Heart Rate Variability in Chronic Pain Patients Compared to Healthy Controls: A Systematic Review and Meta-Analysis

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Abstract

Background: A large body of scientific literature derived from experimental studies emphasizes the vital role of vagal-nociceptive networks in acute pain processing. However, research on vagal activity, indexed by vagally-mediated heart rate variability (vmHRV) in chronic pain patients (CPPs), has not yet been summarized. Objectives: To systematically investigate differences in vagus nerve activity indexed by time and frequency-domain measures of vmHRV in CPPs compared to healthy controls (HCs). Study Design: A systematic review and meta-analysis, including meta-regression on a variety of populations (i.e., clinical etiology) and study-level (i.e., length of HRV recording) covariates. Setting: Not applicable (variety of studies included in the meta-analysis) Methods: Eight computerized databases (PubMed via MEDLINE, PsycNET, PsycINFO, Embase, CINAHL, Web of Science, PSYNDEX, and the Cochrane Library) in addition to a hand search were systematically screened for eligible studies based on pre-defined inclusion criteria. A meta-analysis on all empirical investigations reporting short- and long-term recordings of ontinuous time- (root-mean-square of successive R-R-interval differences [RMSSD]) and frequency-domain measures (high-frequency [HF] HRV) of vmHRV in CPPs and HCs was performed. True effect estimates as adjusted standardized mean differences (SMD; Hedges g) combined with inverse variance weights using a random effects model were computed. Results: CPPs show lower vmHRV than HCs indexed by RMSSD (Z = 5.47, P < .0001; g = -0.24;95% CI [-0.33, -0.16]; k = 25) and HF (Z = 4.54, P < .0001; g = -0.30; 95% CI [-0.44, -0.17]; k = 61).Meta-regression on covariates revealed significant differences by clinical etiology, age, gender, and length of HRV recording. Limitations: We did not control for other potential covariates (i.e., duration of chronic pain, medication intake) which may carry potential risk of bias. Conclusion(s): The present meta-analysis is the most extensive review of the current evidence on vagal activity indexed by vmHRV in CPPs. CPPs were shown to have lower vagal activity, indexed by vmHRV, compared to HCs. Several covariates in this relationship have been identified. Further research is needed to investigate vagal activity in CPPs, in particular prospective and longitudinal follow-up studies are encouraged.

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... An important link between the cardiovascular system and pain regulation mechanisms is the vagus nerve [13]. Pain control occurs through vagally mediated afferent and efferent stimuli [13]. ...
... An important link between the cardiovascular system and pain regulation mechanisms is the vagus nerve [13]. Pain control occurs through vagally mediated afferent and efferent stimuli [13]. The vagus nerve is also known to modulate the ANS [13]. ...
... Pain control occurs through vagally mediated afferent and efferent stimuli [13]. The vagus nerve is also known to modulate the ANS [13]. Impaired vagal tone can be directly measured through the assessment of HRV [10]. ...
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Objectives Autonomic regulation has been identified as a potential regulator of pain via vagal nerve mediation, assessed through heart rate variability (HRV). Non-invasive vagal nerve stimulation (nVNS) and heart rate variability biofeedback (HRVB) have been proposed to modulate pain. A limited number of studies compare nVNS and HRVB in persons with chronic pain conditions. This systematic review compared interventions of nVNS and HRVB in adults with long-standing pain conditions. Methods PubMed, MEDLINE, CINAHL, SPORTDiscus, Google Scholar, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010 and 2023. Search terms included chronic pain, fibromyalgia, headache, migraine, vagus nerve stimulation, biofeedback, HRV, pain assessment, pain, and transcutaneous. Results Ten full-text articles of 1,474 identified were selected for full qualitative synthesis, with a combined population of 813 subjects. There were n = 763 subjects in studies of nVNS and n = 50 subjects for HRVB. Six of the nine nVNS studies looked at headache disorders and migraines (n = 603), with two investigating effects on fibromyalgia symptoms (n = 138) and one the effects on chronic low back pain (n = 22). Of the nVNS studies, three demonstrated significant results in episode frequency, six in pain intensity (PI) reduction, and three in reduced medication use. The HRVB study showed statistically significant findings for reduced PI, depression scores, and increased HRV coherence. Conclusion Moderate to high-quality evidence suggests that nVNS is beneficial in reducing headache frequency and is well-tolerated, indicating it might be an alternative intervention to medication. HRVB interventions are beneficial in reducing pain, depression scores, use of non-steroidal anti-inflammatory medication, and in increasing HRV coherence ratio. HRVB and nVNS appear to show clinical benefits for chronic pain conditions; however, insufficient literature exists to support either approach.
... What's more, parasympathetic nerve function is also involved in pain sensitization. Decreasing vagal activity leads to greater somatic and visceral input via the spinothalamic track, which renders a mechanism for decreased pain threshold and increased pain sensitivity in those with chronic pain (Koenig, Falvay et al., 2016). ...
... In concordance with previous studies (Adler-Neal et al., 2020), our study showed a decrease in parasympathetic activity in ZAP patients. The vagus nerve plays an important role in both the ascending pathway of nociceptive stimuli to the center and descending inhibitory pathways within the dorsal horn of the spinal cord (Koenig, Falvay et al., 2016;Koenig, Loerbroks et al., 2016). Decreased vagus nerve activity results in more nociceptive input. ...
... In the observation of circadian rhythms, sympathetic activity had no increase during day and night according to LF-to-HF ratio. The RMSSD is used to estimate the vagally meditated changes and is strongly associated with the HF power (Koenig, Falvay et al., 2016;Nahman-Averbuch et al., 2014). This study showed a reduced autonomic function and a loss of parasympathetic advantage in patients with ZAP during the night. ...
Article
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Objective To investigate the circadian changes of the autonomic function in patients with zoster‐associated pain (ZAP). Methods A total of 37 patients with ZAP from April 2022 to October 2022 were enrolled as the observation group, and 37 normal volunteers at the same time were selected as the control group. All participants were required to wear a 24‐h Holter, which was used to compare the heart rate variability (HRV) between the two groups. HRV analysis involved time‐ and frequency‐domain parameters. Results There was no statistically significant difference in general information between two groups. Patients with ZAP had an increased mean heart rate and decreased the standard deviation of normal‐to‐normal (SDNN) R–R interval, the root mean square of the differences (RMSSD) in successive RR interval, low frequency (LF), and high frequency (HF) compared with control groups in all periods (p < .05). The ratio of LF/HF between two groups had no significant difference (p = .245). SDNN had no significant difference between day and night in the control group (p > .05), whereas SDNN of ZAP patients in night period was reduced than that in day period (p < .001). The level of RMSSD during the day was lower than those at night in the control group (p < .05), whereas no significant difference of RMSSD between two periods was observed in patients with ZAP (p > .05). Conclusion The results of this study indicated that ZAP contributes to the decline of autonomic nervous system (ANS) function, especially parasympathetic components. The patients with ZAP lost parasympathetic advantage and had a worse ANS during the night.
... The meta-analysis by Tak et al.(Tak et al., 2009) in 2009 supported the low HRV feature in FSSs patients, with an effect size of -0.32 (95 % CI, -0.63 to -0.01). Other meta-analyses focused on chronic pain and IBS identified similar findings (Koenig et al., 2016;Liu et al., 2013). SSDs were not included in these studies, and there were many new HRV studies after publication of the above reviews. ...
... Besides, distinct baseline HRV indices (e.g. only SDNN, only RMSSD, only HF) were analyzed separately for examining the results under lower sample size but higher homogeneity (Koch et al., 2019;Koenig et al., 2016). For HRV reactivity outcomes, the post-challenge HRV indices reflecting parasympathetic functions were grouped to evaluate the differences between FSSs/SSDs and healthy subjects. ...
... Choosing which indices to use in measurements is an important topic for HRV studies (Koch et al., 2019;Koenig et al., 2016;Nunan et al., 2010). In our main analysis for baseline HRV, we adopted a hierarchical approach with previously reported parasympathetic indices; this method has been used in prior HRV meta-analyses Cheng et al., 2019). ...
Article
This research is aimed to systematically review heart rate variability (HRV) findings of functional somatic syndrome (FSSs) and somatic symptom disorders (SSDs), and to compare the HRV values between FSSs/SSDs patients and healthy individuals. We included clinical studies assessing HRV (including baseline HRV and HRV reactivity) in FSSs/SSDs and healthy participants. We searched PubMed, Embase, PsycINFO, MEDLINE, and Web of Science databases from the earliest available date to June 2019. Eighty-five studies comprising 3242 FSSs/SSDs patients and 2321 controls were included in the main meta-analysis; the baseline HRV value was significantly lower compared to healthy individuals (Hedges'g, -0.43; 95% CI, -0.54 to -0.30; p < .001), with the largest effect size in fibromyalgia patients. A significant lower HRV was also found for total variability (Hedges'g, -0.56; 95% CI, -0.77 to -0.36) and specific parasympathetic indices (Hedges'g, -0.41, 95% CI; -0.54 to -0.30). HRV reactivity was significantly lower in FSSs/SSDs patients (Hedges'g, -0.42; 95% CI, -0.64 to -0.20). Our results support the notion that FSSs/SSDs patients have significantly lower HRV than healthy individuals.
... While individuals with greater vm-HRV have greater parasympathetic control over the heart (and thus greater variability in the length of their cardiac cycles, particularly at high frequencies, which are influenced exclusively by parasympathetic input), individuals with lower vm-HRV have parasympathetic nervous systems that are less capable of regulating heart activity (and thus have reduced variability in cardiac cycle length). A growing body of literature and a meta-analysis suggest that individuals with chronic pain may have lower vm-HRV indices at baseline, suggesting lower vagal activity in chronic pain patients (Koenig et al., 2016a(Koenig et al., , 2016b. This effect was robust in fibromyalgia patients but not statistically significant in irritable bowel syndrome (IBS) patients compared to healthy controls, suggesting that not all chronic pain conditions share identical ANS mechanisms (Koenig et al., 2016a). ...
... A growing body of literature and a meta-analysis suggest that individuals with chronic pain may have lower vm-HRV indices at baseline, suggesting lower vagal activity in chronic pain patients (Koenig et al., 2016a(Koenig et al., , 2016b. This effect was robust in fibromyalgia patients but not statistically significant in irritable bowel syndrome (IBS) patients compared to healthy controls, suggesting that not all chronic pain conditions share identical ANS mechanisms (Koenig et al., 2016a). However, differential functioning of these systems at rest demonstrates that it is not specific to pain, at least in chronic pain conditions. ...
Article
Development and validation of pain biomarkers has become a major issue in pain research. Recent advances in multimodal data acquisition have allowed researchers to gather multivariate and multilevel whole-body measurements in patients with pain conditions, and data analysis techniques such as machine learning have led to novel findings in neural biomarkers for pain. Most studies have focused on the development of a biomarker to predict the severity of pain with high precision and high specificity, however, a similar approach to discriminate different modalities of pain is lacking. Identification of more accurate and specific pain biomarkers will require an in-depth understanding of the modality specificity of pain. In this review, we summarize early and recent findings on the modality specificity of pain in the brain, with a focus on distinct neural activity patterns between chronic clinical and acute experimental pain, direct, social, and vicarious pain, and somatic and visceral pain. We also suggest future directions to improve our current strategy of pain management using our knowledge of modality-specific aspects of pain.
... Under high stress, amygdala activation initiates the hypothalamic-pituitaryadrenal axis (HPA axis) response and parasympathetic withdrawal. This enhanced stress load is expressed as decreased cardiac vagal activity, called vagally mediated heart rate variability (vmHRV) (Koenig et al. 2016b). Increased resting vmHRV has been associated with better stress adaptability (Kim et al. 2018), immunomodulation (Thayer and Sternberg 2010) and inflammation (Williams et al. 2019), making this biomarker an attractive tool in endometriosis assessment. ...
... Therefore, the common assumption that the repetitive pain experience leads to disturbance in PNS via perceived stress may not be the only path (Reis et al. 2020). People with a previous lack of PNS tone may be predisposed to develop more severe chronic pain due to the ineffectiveness of critical regulatory systems (indexed by vmHRV) involved in pain processing like inflammation (Williams et al. 2019), immunomodulation (Thayer and Sternberg 2010), and DIP (Koenig et al. 2016b). Although indirect evidence supports this possibility, the crosssectional nature of our study cannot confirm this assumption. ...
Article
Chronic pelvic pain is the main symptom in women with endometriosis. Evidence suggests that psychological stress and autonomic regulation contribute to symptoms and pathophysiological modulation. We investigated the relationship between endometriosis-related pain severity, perceived stress, and autonomic balance in a sample of 81 women suffering chronic pelvic pain with deep endometriosis. Perceived stress and pelvic pain symptoms were assessed using the 10-item version of the Perceived Stress Scale (PSS-10) and the Numeric Pain Rating Scale (NPRS), respectively. Autonomic nervous system regulation was evaluated using vagally mediated components of the heart rate variability (vmHRV). Our results showed that pain unpleasantness and perceived stress were positively correlated, and women with mood disorders had higher perceived stress. The women with low resting vmHRV experience more intense pelvic pain, pain unpleasantness, and a higher number of severe endometriosis-related pain descriptors. The positive association between perceived stress, mood disorder, and pain unpleasantness demonstrates the additive effect between these aversive experiences. The inverse association between parasympathetic tone and pain suggests contributions of the Descending Inhibitory Pain pathway efficiency to symptom severity in women with endometriosis.
... Chronic pain is known to be strictly interrelated with autonomous nervous system (ANS) dysfunction being both its trigger and its consequence [8]. Therefore, not only chronic pain, but also dysautonomic symptoms, such as esophageal dysmotility, diarrhea, occlusive syndrome and altered cardiovascular autonomic control deteriorate SSc patients' HR-QoL [9,10]. ...
... Surprisingly, we also observed that patients who reported higher pain values showed a higher parasympathetic modulation than patients who have lower pain levels, still maintaining an overall sympathetic predominance. The literature evidence suggests that the experience of pain is inversely associated with vagally mediated heart rate variability [8,35,36]. However, most of the comparisons were conducted on healthy subjects not considering a stratification for pain chronicity. ...
Article
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Chronic pain and dysautonomic symptoms deteriorate Systemic sclerosis (SSc) patients’ health-related quality of life with serious repercussions on social life and even on sleep. Heart Rate Variability (HRV) analysis can identify cardiovascular autonomic control impairment in subclinical condition. The aim of the present observational cross-sectional study was to assess the relationship between dysautonomic symptoms, quality of life status and cardiovascular autonomic profile. ECG and respiration were recorded at rest in 20 SSc patients. HRV analysis was performed using two different approaches: Linear spectral analysis and non-linear symbolic analysis. Pain was evaluated using the Numeric Rating Scale (NRS) and 3 questionnaires were administered for the evaluation of sleep quality (PSQI), mood tone (PHQ-9) and disability (HAQ). We found that sleep impairment was related to sympathetic predominance at rest measured as low-frequency/high-frequency ratio (LF/HF) (r = 0.48 and p = 0.033); poorer sleep quality was related to higher pain values (r = 0.48 and p = 0.034) and depressive symptoms (r = 0.82 and p < 0.01); higher pain scores were related to higher cardiovascular vagal modulation and higher disability indexes (r = 0.47 and p = 0.038 & r = 0.55 and p = 0.012, respectively). In conclusion dysautonomia and chronic pain showed a severe impact on sleep quality and disability with a consequent worsening of depressive symptom in our cohort of SSc patients.
... Several studies have consistently shown lower HRV in SSD/FSSs patients than in a healthy population Tak et al., 2009). Meta-analyses revealed that patients with chronic pain, irritable bowel syndrome, and FSSs had significantly lower HRV than healthy controls, especially for parasympathetic-specific indices (Koenig et al., 2016;Liu et al., 2013;Tak et al., 2009). However, the above meta-analyses included mainly baseline HRV activity, and the effect size of the between-group difference is small (Koenig et al., 2016;Tak et al., 2009). ...
... Meta-analyses revealed that patients with chronic pain, irritable bowel syndrome, and FSSs had significantly lower HRV than healthy controls, especially for parasympathetic-specific indices (Koenig et al., 2016;Liu et al., 2013;Tak et al., 2009). However, the above meta-analyses included mainly baseline HRV activity, and the effect size of the between-group difference is small (Koenig et al., 2016;Tak et al., 2009). Hence, the idea that specific biological or psychological challenges may amplify the HRV difference between SSD patients and healthy controls emerged recently . ...
Article
Objective Patients with somatic symptom disorder (SSD) may have declined parasympathetic activity and selective attention to negative information. We combined Stroop tasks and heart rate variability (HRV) measurements to explore the brain mechanism of SSD. Methods 104 SSD patients (64 women) and 100 healthy adults (76 women) received three Stroop tasks (the "cognitive" color-word Stroop, "emotional" emotion Stroop, and "cognitive and emotional" face-word Stroop) with low and high interference conditions. The key HRV indexes included high-frequency power (HF) and a standard deviation of normal to normal RR intervals (SDNN). The generalized estimating equation model was used to examine the effects of SSD on three Stroop tasks performance (accuracy and reaction time) and HRV (HF and SDNN) controlling for sex, age, body mass index, and the levels of anxiety and depression. Results For Stroop tasks, the significant group difference in emotion Stroop task with the high level of interference (SSD patients had lower accuracy than healthy ones) was only found in women. As for HRV, only men during color-word Stroop, women during emotion Stroop revealed significant between-group differences; SDNN in SSD men was higher than healthy men, and HF in SSD women was lower than healthy women controlling for the confounding factors. However, the significantly longer reaction time in SSD women than in healthy women diminished in the adjusted analysis. Conclusion Emotion Stroop task and HRV helps distinguish SSD patients from healthy adults, particularly in women. Sex-specific measures for early detection and intervention for SSD are suggested.
... The main neurotransmitters of the sympathetic nervous system are, in addition to noradrenaline (NE), neuropeptide Y (NPY) and ATP. The parasympathetic nervous system is mainly represented by the pneumogastric (or vagus) nerve [117][118][119][120]. The pneumogastric nerve is the 10th cranial nerve and its action on the gastrointestinal tract is related to food intake, digestion, the maintenance of the gastrointestinal barrier, and immunity. ...
Article
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Aim: This article aims to explore the role of the human gut microbiota (GM) in the pathogenesis of neurological, psychiatric, and neurodevelopmental disorders, highlighting its influence on health and disease, and investigating potential therapeutic strategies targeting GM modulation. Materials and Methods: A comprehensive analysis of the gut microbiota’s composition and its interaction with the human body, particularly, its role in neurological and psychiatric conditions, is provided. The review discusses factors influencing GM composition, including birth mode, breastfeeding, diet, medications, and geography. Additionally, it examines the GM’s functions, such as nutrient absorption, immune regulation, and pathogen defense, alongside its interactions with the nervous system through the gut–brain axis, neurotransmitters, and short-chain fatty acids (SCFAs). Results: Alterations in the GM are linked to various disorders, including Parkinson’s disease, multiple sclerosis, depression, schizophrenia, ADHD, and autism. The GM influences cognitive functions, stress responses, and mood regulation. Antibiotic use disrupts GM diversity, increasing the risk of metabolic disorders, obesity, and allergic diseases. Emerging therapies such as probiotics, prebiotics, and microbiota transplantation show promise in modulating the GM and alleviating symptoms of neurological and psychiatric conditions. Conclusions. The modulation of the GM represents a promising approach for personalized treatment strategies. Further research is needed to better understand the underlying mechanisms and to develop targeted therapies aimed at restoring GM balance for improved clinical outcomes.
... Now it is controversial to postulate that somatoform pain patients could have better pain management capacities than the general population. Comparable with the trend of HRV results in this study, a meta-analysis of chronic pain patients showed a significantly reduced RMSSD in comparison to healthy controls, indicating a lower parasympathetic tone in general [57]. Because of the increased pain sensitivity in these patients, pain regulation mechanisms like the parasympathetic component of HRV still might be activated more often and earlier but starts from a lower initial level. ...
Article
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Objectives The overlapping neural networks of social and physical pain have been investigated intensively in recent years. It was postulated that triggering social pain might result in greater physical pain. Nonetheless, how this affects somatoform pain disorder has not yet been considered. Since an increased pain processing activity is reported in these patients, the investigation of social exclusion and its effect on this group seems interesting. Hence, the aim of this study was to compare the influence of social exclusion on healthy controls and patients with somatoform pain disorder. Methods Nineteen patients with somatoform pain disorder and 19 healthy controls were examined. Cyberball, a virtual ball-tossing paradigm, was used to experimentally induce social exclusion and inclusion. To measure effects on pain perception, pressure pain thresholds and heart rate variability (HRV) were recorded after each round of cyberball. Demographic data, pain medication, and potential psychosocial moderators were collected by questionnaires. Results After social exclusion, pressure pain thresholds were significantly reduced in healthy controls (p < 0.01) as well as somatoform pain patients (p < 0.05), while HRV increased only in patients with somatoform pain disorder (p < 0.05) indicating increased parasympathetic activity. Conclusion This study is the first to analyse the effects of social exclusion on pain perception in somatoform pain disorder. While the reduction in pressure pain thresholds is in line with the social pain literature, the effects on HRV could be interpreted as a form of pain regulation mechanism. However, further research is needed to investigate the role of parasympathetic activity in socially excluded somatoform pain patients.
... One of the most important methods used to evaluate ANS in patients with FM is cardiovascular regulation. 4 A large body of evidence suggests that in patients with FSDs, and in particular in patients with FM, basal heart rate variability (HRV) is lower than in healthy subjects, supporting the potential use of this cardiac parameter as a biological marker of chronic pain (CP) [18,19]. In fact, HRV and its sympathetic and parasympathetic components represent a reliable clinical tool for evaluating the body's ability to cope with acute stress stimuli such as nociceptive stimulation [20] and for this reason it is also considered a biological indicator of human resilience [21]. ...
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Although the pathophysiology of fibromyalgia syndrome has been better understood in recent decades, a unified model of its pathogenesis and an effective therapeutic approach are still far from being realized. The main aim of this article will be to delve into the fundamental mechanisms of the pathophysiology of fibromyalgia conceptualized as stress intolerance syndrome. Using the biopsychosocial model of chronic pain syndromes, we will describe the potential role of the attachment system, C tactile fibers, and oxytocinergic system dysfunction in the pathophysiology of fibromyalgia syndrome and other central sensitivity syndromes. At the end of the article, the therapeutic implications of this new global and translational pathophysiological model will be briefly discussed.
... In einer aktuellen Metaanalyse fanden sich eine reduzierte HRV und auch HRV-Reaktivität in verschiedenen zeit-und frequenzbasierten HRV-Parametern bei funktionellen somatischen Syndromen und der somatischen Belastungsstörung (Cheng et al. 2020). In einer weiteren Metaanalyse zur HRV bei chronischen Schmerzen und funktionellen somatischen Syndromen wurden ähnliche Effekte festgestellt, jedoch auf 2 HRV-Parameter beschränkt (Koenig et al. 2016). Insgesamt sprechen die Ergebnisse verschiedener Metaanalysen trotz heterogener Einzelstudienergebnisse für eine verringerte HRV bei chronischen Schmerzen und der somatischen Belastungsstörung. ...
Article
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Zusammenfassung Hintergrund Bei chronischen Schmerzen zählt die kognitive Verhaltenstherapie (KVT) zu den empfohlenen Behandlungsansätzen, wobei die Effekte im Durchschnitt klein sind. Die KVT adressiert jedoch hauptsächlich psychobehaviorale und kaum physiologische Prozesse. Eine Möglichkeit zur Erweiterung der KVT könnte das Herzratenvariabilitäts-Biofeedback (HRV-BF) darstellen. Frühere Studien stellten eine reduzierte HRV bei chronischen Schmerzen und ihre Verbesserung nach HRV-BF fest. Demnach erscheint gerade die Kombination beider Therapien aussichtsreich. Ziel der Arbeit In der vorliegenden Arbeit soll die Entwicklung eines Kombinationsmanuals aus KVT und HRV-BF beschrieben werden. Eine Überprüfung der Machbarkeit erfolgt im Rahmen einer aktuell stattfindenden randomisierten kontrollierten Pilotstudie. Materialien und Methode Die Methode basiert auf einer Integration ausgewählter Techniken der KVT mit HRV-BF-Elementen, die auf ihre Synergieeffekte und die Machbarkeit hin überprüft werden. Die Pilotstudie soll an 20 Patient*innen mit chronischen muskuloskelettalen Schmerzen (gemäß der 11. Version der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme [ICD-11]) bei Vorliegen einer somatischen Belastungsstörung (gemäß der 5. Auflage des Diagnostischen und Statistischen Manuals Psychischer Störungen [DSM-5]) durchgeführt werden. Ergebnis Die entwickelte Kurzzeittherapie besteht aus 12 Sitzungen. Therapieziele sind z. B. der Aufbau adaptiver Verhaltensweisen, die Umstrukturierung maladaptiver Kognitionen sowie Verbesserungen der Emotionsregulation und der HRV-Selbstregulation. Diskussion Durch die integrierte Kurzzeittherapie können über psychobehaviorale Prozesse hinaus auch potenziell relevante psychophysiologische Prozesse adressiert werden. Obwohl es bereits Erkenntnisse zur Wirksamkeit sowohl der KVT als auch von HRV-BF gibt, steht die Bewertung des Nutzens ihrer gemeinsamen Anwendung noch aus.
... These in turn are supported by a network of cortical and subcortical brain areas that can facilitate or inhibit nociceptive afferent brain input via brainstem nuclei [3]. In chronic pain conditions, there is altered modulation of such inhibitory pathways [4], as well as dysfunction of the autonomic nervous system (ANS) [5]. The ANS comprises the sympathetic and parasympathetic nervous systems, in which the latter is dominated by the vagus nerve, involved in many physiological processes, including cardiovascular function and gastrointestinal responses, and has recently been shown to also be involved in pain regulation [6,7]. ...
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Disordered autonomic nervous system regulation and supraspinal pain inhibition have been repeatedly described in chronic pain. We aimed to explore the effects of δ-9-tetrahydrocannabinol (THC), an emerging treatment option, on autonomic nervous system and central pain modulation measures in patients with chronic pain. Twelve male patients with chronic radicular neuropathic pain participated in a randomized, double-blind, crossover, placebo-controlled, single-administration trial. Low/high frequency (LF/HF) heart rate variability (HRV) ratio and conditioned pain modulation (CPM) response were measured and resting-state functional magnetic resonance imaging (MRI) was performed at baseline and after sublingual administration of either 0.2 mg/kg oral THC or placebo. THC significantly reduced the LF/HF ratio compared with placebo (interaction effect F(1,11) = 20.5; p < 0.005) and significantly improved CPM responses (interaction effect F(1,9) = 5.2; p = 0.048). The THC-induced reduction in LF/HF ratio correlated with increased functional connectivity between the rostral ventrolateral medulla and the dorsolateral prefrontal cortex [T(10) = 6.4, cluster p-FDR < 0.005]. THC shifts the autonomic balance towards increased parasympathetic tone and improves inhibitory pain mechanisms in chronic pain. The increase in vagal tone correlates with connectivity changes in higher-order regulatory brain regions, suggesting THC exerts top-down effects. These changes may reflect a normalizing effect of THC on multiple domains of supraspinal pain dysregulation. NCT02560545.
... Several factors affect the autonomic nervous system, including chronic pain 30) , neuropathic pain 31) , sleep disorders 28) , stress 32) , and mood disorders 33) , each of which can be evaluated using questionnaires and indices. In this study, we determined that the NRS, Pain DETECT, and AIS scores were higher in the failure group than in the good group. ...
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Purpose] We aimed to determine the autonomic response in patients with rotator cuff tear-related nocturnal pain using nonlinear analysis of heart rate variability. [Participants and Methods] Twenty-eight patients with nocturnal pain who were diagnosed with a rotator cuff tear and received steroid injections, and whose nocturnal pain improved, were divided into a control group (14 patients) and a failure group (14 patients). Pulse wave was measured continuously using BACS Advance equipment (TAOS Co.) for a total of 17 min: 5 min before isometric hand grip, 2 min during isometric hand grip, 5 min after isometric hand grip, and 10 min after isometric hand grip. The autonomic nervous system activity was assessed using detrended fluctuation analysis and approximate entropy. [Results] The α1 values obtained from the detrended fluctuation analysis were significantly higher in the failure group than in the control group at each measurement period. The approximate entropy was normal in 12 (85%) patients in the control group and six (42%) patients in the failure group; it was abnormal in two (15%) patients in the control group and eight (58%) patients in the failure group. [Conclusion] Among patients experiencing nocturnal pain, several have abnormal autonomic response during isometric hand grip.
... To, date, initial evidence suggests autonomic imbalance in form of reduced HRV in somatoform disorders, pain conditions, and FSS [20,21]. These disorders are highly similar to SSD. ...
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Background Preliminary evidence suggests altered heart rate variability (HRV) and impaired emotion regulation (ER) in somatic symptom disorder (SSD). Moreover, HRV can be considered an index of ER. Yet, to date, research on HRV and emotional reactivity in SSD is scarce and findings are inconsistent. Thus, this study aimed to examine ER differences, HRV at rest, and in response to emotion induction in persons with SSD compared to controls. Methods The sample comprised 44 persons with SSD (DSM-5; 79.5% female, M age = 45.7, SD = 14.7) and 41 persons without SSD (non-SSD; 78% female, M age = 44.2, SD = 14.7). We assessed the participants’ somatic symptom severity, ER, and control variables (e.g., depressive symptoms). Frequency and time domain HRV by ECG and subjective emotional states were measured at rest, under sadness induction, and during recovery periods. We evaluated baseline between-group differences with t -tests, and HRV and emotional reactivity and recovery with repeated measures ANOVAs. Results We found no significant differences in resting state HRV between persons with and without SSD. Regarding reactivity and recovery, SSD group showed lower reactivity in SDNN (standard deviation of NN interval) than non-SSD group. Moreover, SSD group reported more maladaptive ER techniques (e.g. rumination) and a higher effort to regulate their emotions during the experiment than non-SSD group. Conclusions The study indicated impaired ER in persons with SSD. This finding showed more clearly in self-report than in HRV. Further research on HRV reactivity including tasks evoking other negative emotions in persons with SSD is required.
... Indeed, ANS has an inhibitory regulatory effect on pain 62 . The vagus nerve, a parasympathetic nerve, plays a role in pain processing in nociceptive transmission to the brain, and patients with chronic pain have less vagal activity than healthy controls 63 . The vagus nerve integrates motor and sensory information through its nuclei, including nociceptive information 64 . ...
Article
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Fibromyalgia is a chronic condition of unknown etiology unrelated to specific laboratory markers for diagnosis because of poor etiopathogenesis. In general, the changes common to fibromyalgia are also seen in other chronic pain conditions, making the pathogenesis controversial among different pathological conditions. The unknown etiology makes the diagnosis difficult and consequently has repercussions on a not so effective treatment of patients with fibromyalgia. The restoration of systemic disorders provides a wide spectrum of therapeutic possibilities with the potential to guide professionals in establishing goals and evaluation methods. Therefore, this narrative review discusses the etiological and pathophysiological hypotheses involved in the development of fibromyalgia.
... Systematic reviews summarizing the utility of heart rate variability (HRV) for assessing autonomic nervous system (ANS) activity via the vagus nerve in those with pain [11][12][13][14][15] have recently come to the forefront as researchers investigate the validity of the metric as a measurement of treatment success for various conditions. Systematic reviews include those combining HRV with headache [16], fibromyalgia [17], long-standing fatigue syndrome [17,18], and long-standing low back pain [19]. ...
Article
Objectives: Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain. Methods: Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010-2021. Search terms included: chronic neck pain, neck pain, cervical pain, manual therapy, mobilization, manipulation, osteopathy, osteopathic or chiropractic. Heart rate variability, HRV, heart rate variation, effects, outcomes, benefits, impacts or effectiveness. Results: Of 139 articles located and screened, three full-text articles were selected for full qualitative synthesis, with a combined population of 112 subjects, 91 of which were female, with an average age of 33.7 ± 6.8 years for all subjects. MT techniques in three studies were statistically significant in improving HRV in people with LNP; however, techniques were differed across studies, while one study showed no benefit. The studies were found to be of high quality with PEDro scores ≥6. Conclusions: Although no clear cause and effect relationship can be established between improvement in HRV with manual therapy, results supported the use of MT for an acute reduction in HRV. No one particular method of MT has proven superior, MT has been found to produce a statistically significant change in HRV. These HRV changes are consistent with decreased sympathetic tone and subjective pain.
... In contrast, altered HRV has been linked to somatoform disorders, but the association is not clear. Some studies found evidence for reduced HRV in patients with chronic pain or FSS (e.g., (12,13)). The existing few studies on HRV in SSD also reported indicators of altered autonomic functioning (14,15). ...
Article
Objective: Patients with somatic symptom disorder (SSD) often receive targeted intervention only after a long duration of illness. Moreover, the reported effect-sizes of interventions for SSD are small. Therefore, improvement and evaluation of interventions are needed. Preliminary evidence suggests autonomic imbalance, e.g. lower heart rate variability (HRV) in SSD. HRV biofeedback (HRV-BF) as a method for self-regulation shows initial positive effects in chronic pain and functional syndromes. The aim of this study is to evaluate the efficacy of a brief HRV-BF intervention for SSD. Methods: Of a total of 50 participants with SSD (DSM-5) who were recruited and randomly assigned to four sessions of HRV-BF (n = 25) or autogenic training (AT, n = 25), 49 participants were analyzed (female 77.6%; mean age = 45.3, SD = 14.4). The primary outcomes were somatic symptom severity (SOMS-7, NRS) and HRV. Secondary outcomes were psychological characteristics of SSD (e.g. SSD-12, health concerns, emotion regulation). The data were collected before and after intervention and were analyzed with repeated measures ANOVAs and post-hoc t-tests. Results: Symptom severity improved after both, HRV-BF and AT. SDNN ("Standard Deviation of the NN Intervall") and psychological symptoms improved significantly more strongly in the HRV-BF than in the AT group (ηp2 interaction = .10; p = .047). Conclusions: The improvements in somatic symptoms, but specifically in cognitive-affective symptoms and autonomic regulation suggest that HRV-BF with only four sessions is a potentially useful intervention option for SSD. Thus, adding this short HRVBF intervention to existing psychological treatments for SSD may be promising.Trial registration number: The described trial has been registered at the German Clinical Trial Register Platform following the number DRKS00017099 (https://www.drks.de).
... Systematic reviews summarizing the utility of heart rate variability (HRV) for assessing autonomic nervous system (ANS) activity via the vagus nerve in those with pain [11][12][13][14][15] have recently come to the forefront as researchers investigate the validity of the metric as a measurement of treatment success for various conditions. Systematic reviews include those combining HRV with headache [16], fibromyalgia [17], long-standing fatigue syndrome [17,18], and long-standing low back pain [19]. ...
Article
Clinical scenario: Recent systematic reviews show conflicting information regarding the effect of concussion on cardiac autonomic function. Controlled aerobic exercise is the most popular intervention for those recovering from a concussion. There is a gap in the literature supporting the utility of objective metrics during exertional return to play protocols and rehabilitation. Clinical question: Can heart rate variability (HRV) during physical exertion be a reliable biomarker over time for those who suffered a sport-related concussion? Summary of key findings: A literature search produced 3 studies relevant to the clinical question. One, a prospective-matched control group cohort study, reported disturbances in HRV during physical exertion in those with a history of concussion, and identified persistent HRV dysfunction after resolution of subjective complaints, return to play, and with multiple concussive events. Second, a cross-sectional cohort study found an HRV difference in those with and without a history of concussion and in HRV related to age and sex. Finally, the prospective longitudinal case-control cohort study did not find sex or age differences in HRV and concluded that, although postconcussion HRV improved as time passed, resting HRV was not as clinically meaningful as HRV during exertional activities. Clinical bottom line: There is emerging evidence to support the use of HRV as an observable biomarker, over time, of autonomic function during physical exertion following a sport-related concussion. However, the meaningfulness of HRV data is not fully understood and the utility seems individualized to the level of athlete, age, and sex and, therefore, cannot be generalizable. In order to be more clinically meaningful and to assist with current clinical decision making regarding RTP, a preinjury baseline assessment would be beneficial as an individualized reference for baseline comparison. Strength of recommendation: Although HRV is not fully understood, currently, there is grade B evidence to support the use of individualized baseline exertional HRV data as comparative objective metric to assess the autonomic nervous system function, over time, following a concussive event.
... Для подолання хронічного болю також важливо, у якому психологічному стані перебуває пацієнт переважну більшість часу хвороби та як сприймає біль [17]. Для зниження суб'єктивної складової відчуття болю важливо розслабитися та зменшити прояви хронічного стресу [18] Майстри Рейкі говорять про вплив не на хворий орган або ділянку тіла, а на стан всього організму, про що свідчать одночасні різноманітні ефекти впливу [1; 23]. ...
Article
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Bioenergy therapy method Reiki, existing since 1922, is widespread in Europe, Asia, North America, Australia, and the former Soviet Union. According to the US National Center for Complementary and Integrative Health (NCCIH), Reiki belongs to the methods of com­plementary and alternative medicine, but is increasingly used as a standard procedure in hospitals, hospices and rehabilitation centers. Most of the published results of Reiki efficacy studies relate to pain relief, anxiety, depression, and fatigue. The effects of Reiki for reducing the effects of strokes, epilepsy, normalization of the nervous, immune and endocrine systems in the rehabilitation and overcoming the effects of distress are studied. Studies concern humans, animals, and bacterial cultures. Special attention should be paid to recent studies conducted with a large number of patients, design and methods of evaluation of results that meet the standards of modern traditional evidence-based medicine. To determine promising areas for further research, PubMed information on the proven effects of Reiki on chronic and acute pain, stress-induced states, motor and sensitivity functions, immunity, metabolic and hormonal processes, inflammation, edema, microcirculation in the perspective of physical therapy and rehabilitation. Among the studies of the last twenty years are studies with small samples of patients and animals, which contain interesting hypotheses about the possible mechanisms of action of Reiki. In particular, this is a study by Dyer N.L. et al. (2019). The high interest of researchers in Reiki therapy and good acceptance of the method by many patients were noted. Researchers constantly note that the study of the effectiveness of Reiki should be continued, and determine what part of the effect belongs to the placebo. Other aspects of impact require standardization of methods, randomization, blinding, and strict control of results. Keywords: Reiki, physical therapy, rehabilitation, clinical effects, evidence-based medicine.
... These studies have predominantly found evidence for decreased cardiac parasympathetic tone (26,31), and one suggested increased sympathetic tone without change to parasympathetic tone (17). It is worth noting that a recent meta-analysis by Koenig et al. on multiple chronic pain conditions, including IBS and FMS (frequently comorbid with IC/BPS), found similar alterations in HRV and suggest that vagal withdrawal is an important aspect of central pain sensitization (32). ...
Article
Full-text available
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a highly heterogeneous chronic and debilitating condition which effects millions of women and men in the United States. While primarily defined by urinary symptoms and pain perceived to be emanating from the bladder, IC/BPS patients frequently have co-occurring conditions and symptoms, many of which affect diverse body systems related to autonomic nervous system function. The impact on the autonomic system appears to stem from increased sympathetic innervation of the urinary tract, along with increased systemic sympathetic tone and decreased parasympathetic tone. Concurrent with these findings is evidence for destruction of peripheral sympathetic innervation to the sweat glands which may relate to small fiber polyneuropathy. It is unknown to what degree the wider alterations in autonomic function are also related to destruction/alterations in the small fibers carrying autonomic innervation. This potential nexus is an important point of investigation to better understand the unclarified pathophysiology of interstitial cystitis/bladder pain syndrome, the numerous co-occurring symptoms and syndromes, and for the identification of novel targeted therapeutic strategies.
... During decades of subsequent studies of the interrelationships between the cardiovascular and pain-regulating systems, their complexity indicated in the earlier studies was often overlooked Davydov, 2017;Ledowski, Reimer, Chavez, Kapoor, & Wenk, 2012). Many scientific publications on the relationships have been devoted to mainly a reduced respiratory sinus arrhythmia or a power of the heart rate variability associated with respiration (i.e., in its high frequency band) as an indicator of reduced cardiac vagal reactivity in chronic pain populations (Koenig et al., 2016;Tracy et al., 2016). Moreover, more severe chronic pain was found to be associated with a greater reduction in this heart rate variability . ...
Chapter
The view that the cardiovascular system and systems regulating pain perception are closely interrelated was predicted by a variety of findings in the 1970s. This early viewpoint was later confirmed in numerous experimental, clinical, populational, and prospective studies. It is now evident that acute and persistent noxious stimuli and conditioned pain-related behavior, feelings, and thoughts may affect mechanisms regulating cardiovascular activity (e.g., provoke hypertension development). Moreover, the regulation of individual unconditioned and conditioned responses to noxious stimuli may be modified by common mechanisms also regulating cardiovascular and metabolic activity (e.g., by a central inhibition mechanism determining baroreflex bradycardia and by energy supply mechanisms in active and relaxing conditions determining coupling of the heart beating with muscle and respiration activities, respectively). Numerous baroreflex and related cardiovascular variables are suggested for predicting and indicating (as a pain-o-meter) pain severity, its duration and frequency along with pain coping (adaptation and resilience) mechanisms to improve profiling and correct management of individuals with chronic pain syndromes. Moreover, the baroreflex mechanisms are now used in pain control and management. This chapter discusses the history and modern viewpoints on mechanisms of the relationships between pain and cardiovascular systems.
... Previous studies using various methodologies, including heart rate variability (HRV), demonstrated sympathetic hyperactivity [1][2][3][4] and parasympathetic hypoactivity [1][2][3][4][5] in patients with episodic migraine (EM). Similar findings in other pain-related disorders such as fibromyalgia [6], irritable bowel syndrome [7], neck/shoulder pain [8], and neuropathic pain [9] further strengthen the involvement of ANS dysfunction across different painful conditions [10][11][12]. Chronic migraine (CM), a subtype of migraine, is an even more disabling headache disorder and is defined as headaches on more than 15 days per month for ≥3 months, with at least 8 of them with migraine in a month [13]. Although CM affects approximately 2% of the global population [14,15], no study specifically evaluated ANS dysfunction using HRV in patients with CM. ...
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Background : Chronic migraine (CM) is a disabling headache disorder. Autonomic nervous system (ANS) disturbance, as evidenced from heart rate variability (HRV) studies, has been documented in patients with episodic migraine and other pain disorders but not specifically in patients with CM. This study aimed to explore whether the HRV in patients with CM was impaired and whether it could be used to predict treatment outcomes. Methods : Patients with CM were recruited, along with age- and gender-matched healthy controls (CTLs). The time-domain, frequency-domain, and nonlinear metrics of HRV were calculated to evaluate the sympathetic and parasympathetic aspects of ANS function in patients with CM before and after 3-month (12 weeks) treatment with flunarizine as well as in CTLs. The patients were asked to keep a headache diary throughout the study period to determine the treatment efficacy. Results : A total of 81 patients with CM and 58 CTLs completed the study. Most HRV values in patients with CM were significantly lower than those in CTLs, suggesting decreased overall autonomic modulation and parasympathetic hypofunction but not sympathetic dysfunction. By unsupervised clustering analysis, patients with CM were divided into two cluster groups with high and low HRV at baseline. Patients with high baseline HRV, which was comparable to that of CTLs, showed significantly higher absolute and relative reductions in averaged monthly headache days across a 3-month preventive treatment compared with patients with low baseline HRV (-9.1 days vs. -6.4 days or -43.2% vs. -30.1%, both p < 0.05). The HRV increased after preventive treatment in the low-HRV group but not in the high-HRV group. Conclusions : HRV could distinguish patients with CM from CTLs, indicating the involvement of ANS dysfunction. Moreover, patients with CM having a near-normal baseline HRV, indicating a preserved parasympathetic function and overall ANS modulation reservoir, predicted a better outcome to preventive treatment with flunarizine than those with low HRV. Trial registration: Neurologic Signatures of Chronic Pain Disorders, NCT02747940. Registered 22 April 2016, https://clinicaltrials.gov/ct2/show/NCT02747940
... Studies suggest that both taVNS and slow breathing improve affective state (32,43,166); therefore, a combination of both may produce additive or synergistic beneficial effects in individuals with chronic pain through the improvement of emotional state. Furthermore, chronic pain is related to diminished vagal heart control and baroreflex sensitivity (101,107,227) and regular slow breathing has been shown to increase vagal heart control among chronic pain patients (58,218,220). Because of the modulation of affective state, combining taVNS with slow breathing could be also effective for depression related to chronic pain and for functional pain syndromes (such as fibromyalgia, irritable bowel syndrome, or interstitial cystitis), which are often comorbid with affective and anxiety disorders and are accompanied by disrupted sympathovagal balance (228)(229)(230)(231). ...
Article
Full-text available
Objectives Transcutaneous auricular vagus nerve stimulation (taVNS) is a relatively novel noninvasive neurostimulation method that is believed to mimic the effects of invasive cervical VNS. It has recently been suggested that the effectiveness of taVNS can be enhanced by combining it with controlled slow breathing. Slow breathing modulates the activity of the vagus nerve and is used in behavioral medicine to decrease psychophysiological arousal. Based on studies that examine the effects of taVNS and slow breathing separately, this article speculates on some of the conditions in which this combination treatment may prove effective. Furthermore, based on findings from studies on the optimization of taVNS and slow breathing, this article provides guidance on how to combine taVNS with slow breathing. Materials and Methods A nonsystematic review. Results Both taVNS and slow breathing are considered promising add-on therapeutic approaches for anxiety and depressive disorders, chronic pain, cardiovascular diseases, and insomnia. Therefore, taVNS combined with slow breathing may produce additive or even synergistic beneficial effects in these conditions. Studies on respiratory-gated taVNS during spontaneous breathing suggest that taVNS should be delivered during expiration. Therefore, this article proposes to use taVNS as a breathing pacer to indicate when and for how long to exhale during slow breathing exercises. Conclusions Combining taVNS with slow breathing seems to be a promising hybrid neurostimulation and behavioral intervention.
... Pain and anesthetic agents alter heart rate variability Given that the autonomic nervous system is significantly affected by the experience of pain, 30 31 it is likely that autonomic parameters such as HRV are altered in the setting of pain. In support of this notion, HRV changes have been reported in a variety of patients with chronic pain conditions, 32 such as breakthrough pain in cancer, 33 complex regional pain syndrome, 34 fibromyalgia 35 and chronic neck pain. 36 ...
Article
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Introduction Surgical interventions can elicit neuroendocrine responses and sympathovagal imbalance, ultimately affecting cardiac autonomic function. Cardiac complications account for 30% of postoperative complications and are the leading cause of morbidity and mortality following non-cardiac surgery. One cardiovascular parameter, heart rate variability (HRV), has been found to be predictive of postoperative morbidity and mortality. HRV is defined as variation in time intervals between heartbeats and is affected by cardiac autonomic balance. Furthermore, altered HRV has been shown to predict cardiovascular events in non-surgical settings. In multiple studies, experimentally induced pain in healthy humans leads to reduced HRV suggesting a causal relationship. In a different studies, chronic pain has been associated with altered HRV, however, in the setting of clinical pain conditions, it remains unclear how much HRV impairment is due to pain itself versus autonomic changes related to analgesia. We aim to review the available evidence describing the association between postsurgical pain and HRV alterations in the early postoperative period. Methods and analysis We will conduct a scoping review of relevant studies using detailed searches of MEDLINE and EMBASE, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Included studies will involve participants undergoing non-cardiac surgery and investigate outcomes of (1) measures of pain intensity; (2) measures of HRV and (3) statistical assessment of association between #1 and #2. As secondary review outcomes included studies will also be examined for other cardiovascular events and for their attempts to control for analgesic treatment and presurgical HRV differences among treatment groups in the analysis. This work aims to synthesise available evidence to inform future research questions related to postsurgical pain and cardiac complications. Ethics and dissemination Ethics review and approval is not required for this review. The results will be submitted for publication in peer-reviewed journals.
... The overall association between MUPS and low RMMSD was smaller than between MUPS and low HF-HRV, which is surprising because these measures are known to be highly correlated (92) and is inconsistent with a previous meta-analysis on HRV in chronic pain that also included studies on fibromyalgia and irritable bowel syndrome (93). However, a similar meta-analysis that included studies on fibromyalgia but not on irritable bowel syndrome demonstrated significant differences between patients and controls only in HF-HRV and not in RMSSD (25). ...
Article
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Objective: Medically unexplained physical symptoms (MUPS) and related syndromes are common and place a substantial burden on both patients and society. Chronic psychological distress and dysregulation of the autonomic nervous system may be common factors associated with MUPS, although previous studies have reported mixed results. The aims of this meta-analysis are to provide an updated synthesis of studies investigating heart rate variability (HRV) indices associated with autonomic nervous system functioning in three common MUPS syndromes and to explain inconsistencies in previous study findings. Methods: Literature search yielded 58 studies comparing HRV indices of reduced parasympathetic activity of healthy individuals with those of patients with chronic fatigue syndrome (npatients = 271), irritable bowel syndrome (npatients = 1005), and fibromyalgia (npatients = 534). Separate random-effects meta-analyses were conducted on studies measuring root mean square of successive differences (RMSSD) and high-frequency HRV (HF-HRV). Results: Regardless of syndrome type, patients had significantly lower RMSSD (k = 22, Hedges g = -0.37 [-0.53 to -0.21], p < .001) and HF-HRV (k = 52, Hedges g = -0.69 [-1.03 to -0.36], p < .001) than did healthy individuals. Sample age and publication year explained a substantial variation in RMSSD, whereas controlling for confounders in statistical analyses explained variation in HF-HRV. Conclusions: Lower RMSSD and HF-HRV in patients with MUPS versus healthy controls indicates that autonomic nervous system dysregulation, particularly lower parasympathetic activity, may play a role in patients with these conditions. This conclusion may have important implications for the underlying mechanisms and treatment of MUPS and related syndromes.
... Furthermore, distinct resting HRV indices (e.g. only HF, only RMSSD, only SDNN, only RSA) were analysed separately for examining the results with a lower sample size but higher homogeneity (Cheng et al., 2020;Koch et al., 2019;Koenig et al., 2016). For HRV reactivity outcomes, the post-challenge HRV indices reflecting parasympathetic functions were grouped to evaluate the differences between dementia/NCD patients and healthy subjects. ...
Article
Objective: Heart rate variability, a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower heart rate variability (various indices) than healthy controls, and different types of dementia had distinct heart rate variability features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies. Methods: We gathered studies comparing heart rate variability in patients with dementia and in healthy controls. Heart rate variability was analysed in several ways: parasympathetic function in hierarchical order (main analysis), total variability, comparison of heart rate variability between different subtypes of dementia, specific indices of heart rate variability and heart rate variability reactivity. Results: In the initial search, we found 3425 relevant articles, from which 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the main meta-analysis. The dementia patients had a significantly lower resting heart rate variability for parasympathetic function (Hedges' g = -0.3596, p = 0.0002) and total variability (Hedges' g = -0.3059, p = 0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, heart rate variability was significantly lower in patients with mild cognitive impairment (Hedges' g = -0.3060) and in patients with dementia with Lewy bodies (Hedges' g = -1.4154, p < 0.0001). Relative to patients with Alzheimer's disease, heart rate variability in patients with dementia with Lewy bodies was significantly lower (Hedges' g = -1.5465, p = 0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size. Conclusion: Our results show that dementia patients (especially those with dementia with Lewy bodies and mild cognitive impairment) have lower parasympathetic activity than healthy people. The influence of gender on the results should be carefully interpreted.
... Finally, literature on HRV as an instrument that may reflect an imbalance of ANS in patients with chronic pain conditions (specifically in those patients who have shown an overlap in the CS symptoms) is scarce. 101 We are confident that the selected CS assessment instruments are considered the best available and combined will be able to comprehensively measure from the different reference clinical symptoms and signs indicative of CS being present. This will provide further insights on the mechanisms of CS and assist on the phenotyping of centrally sensitised patients with CLBP. ...
Article
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Introduction A relevant subsample of patients with chronic low back pain (CLBP) have manifested augmented central pain processing, central sensitisation (CS). Patients with CLBP have limited functioning and participation. Theoretically, physical functioning in patients with CLBP can plausibly be linked to CS; however, evidence to explain such association is scarce. Moreover, there is no gold standard for CS diagnosis. The objectives of the study are: (1) to analyse the association between instruments assessing reference symptoms and signs attributed to CS; (2) to analyse whether reference symptoms and signs attributed to CS are associated with functioning measurement outcomes; and (3) to analyse whether changes (between baseline and discharge) in reference symptoms and signs attributed to CS are related to changes in each of the functioning measurement outcomes. Methods and analysis A cross-sectional and longitudinal observational study is performed with measurements taken at baseline and discharge of an interdisciplinary rehabilitation programme. A sample size of 110 adult patients with CLBP has been calculated for the study. CS measurements are: Central Sensitisation Inventory, quantitative sensory testing and heart rate variability. Functioning measurements are: lifting capacity, maximal aerobic capacity, accelerometry and reported functioning. Statistical analyses to be performed are: (1) correlation between CS measurements, (2) multiple regression between functioning (dependent variable) and CS measurements (independent variable), and (3) multiple regression between changes in scores of functioning (dependent variable) and CS measurements (independent variable), and corrected for sex and age. Ethics and dissemination The study obtained the clearance to its implementation from the Medical Research Ethics Committee of the University Medical Center Groningen in July 2017. The results will be disseminated through scientific publications in peer-reviewed journals, presentations at relevant conferences, and reports to stakeholders. Trial registration number NTR7167/NL6980.
Article
BACKGROUND Non-verbal persons with intellectual disabilities (ID) may suffer from pain or discomfort, but caregivers may not notice this because of the communication difficulties. Previously, we conducted a study in which professional caregivers used heart rate (HR) monitoring to identify situations that cause acute pain or distress in the everyday life of non-verbal persons with ID. OBJECTIVE To explore professional caregivers’ experience with using HR monitors to better understand non-verbal persons with ID. METHODS Fifteen professional caregivers and 30 final-year students of social education were recruited as informants based on their experience with HR monitoring in non-verbal persons. The informants were interviewed, and they responded to a questionnaire with open-ended questions. The qualitative data were analysed thematically. RESULTS Caregivers reported that HR monitoring provided information about acute pain, acute or prolonged distress, occurrence of epileptic seizures, and the non-verbal persons’ preferences and dislikes. HR data had to be interpreted contextually to be meaningful. Some informants found HR monitoring time-consuming or the interpretation of HR data challenging due to multiple possible causes of increased HR. CONCLUSIONS Caregivers experience HR monitoring as a potentially important source of information that may help them better understand non-verbal persons with ID.
Article
Objectives Chronic pain disorders are among the most common and affect approximately 20% of the US population, leading to disproportionately high medical expenditures and negative economic impact. Behavioral factors of pain catastrophizing and perceived injustice are associated with pain intensity in chronic pain. Diminished heart rate variability (HRV) is also strongly associated with chronic pain. These factors have been less explored earlier in the pain experience and it is unclear whether they play a role in the transition from acute to chronic pain. The aim of this study was to determine the relationship between pain catastrophizing, perceived injustice, pain intensity and HRV in naturally occurring acute pain. Methods Ninety-seven subjects were recruited from local outpatient physical therapy clinics. Seated HRV was captured on ninety-four subjects via Polar chest strap while subjects were taking a survey via iPad. In addition to sociodemographic data, the survey included the Pain Catastrophizing Scale (PCS), Injustice Experience Questionnaire (IEQ), and Numeric Pain Rating Scale (NPRS). The natural log of high frequency power (lnHFP) HRV was used in the statistical analysis. Results Multiple regression modeling revealed that lower pain catastrophizing, higher perceived injustice, and lower pain intensity were associated with lower HRV, and accounted for 11.4% of the variance in HRV. Discussion While greater chronic pain intensity is associated with lower HRV, the relationship is reversed in the setting of acute pain. These findings highlight the need to better understand the unique factors that contribute to lower HRV in the acute phase.
Article
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Objective Heart rate variability (HRV) is an important non-invasive marker for the assessment of an organism’s autonomic physiological regulatory pathways. Lower HRV has been shown to correlate with increased mortality. HRV is influenced by various factors or diseases. The aim of this narrative review is to describe the current state of knowledge on factors influencing HRV and their significance for interpretation. Methods The narrative review only included reviews, meta-analyses, and cohort studies which were published until 2021. HRV confounders were grouped into four categories (non-influenceable physiological factors, diseases, influenceable lifestyle factors and external factors). Results The review found that HRV was decreased not only in non-influenceable physiological factors (e.g., age, gender, ethnicity) but also in connection with various number of acute and chronic diseases (e.g., psychiatric diseases, myocardial infarction, heart failure), influenceable lifestyle factors (e.g., alcohol abuse, overweight, physical activity), and external factors (e.g., heat, noise, shift work, harmful- and hazardous substances). Conclusion In order to improve the quality of HRV studies and to ensure accurate interpretation, it is recommended that confounders be taken into account in future diagnostic measurements or measurements in the workplace (e.g., as part of health promotion measures) in order to counteract data bias.
Chapter
This chapter explores yoga as a salutogenic intervention supportive of eudaimonic well-being with its wide-spread health effects for various patient populations. Autonomic nervous system regulation and resilience are considered as important meditators for the promotion of biopsychosocial health. Polyvagal theory offers a novel perspective on how underlying neural platforms support combined physiological, psychological, and behavioral states—inclusive of eudaimonic well-being. This chapter describes the convergence of neurophysiological ideas of neuroception, interoception, and neural platforms with yoga foundational concepts such as discriminative wisdom and the gunas. This translatory language of eudaimonic well-being and polyvagal theory offers a framework for yoga to be understood and integrated into current healthcare and research contexts while maintaining its unique perspective and foundational wisdom.
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Although the pathophysiology of fibromyalgia syndrome has been better understood in recent decades, a unified model of its pathogenesis and an effective therapeutic approach are still far from being realized. The main aim of this article will be to delve into the fundamental mechanisms of the pathophysiology of fibromyalgia conceptualized as stress intolerance syndrome. Using the biopsychosocial model of chronic pain syndromes, we will describe the potential role of the attachment system, C-tactile fibers, and oxytocinergic system dysfunction in the pathophysiology of fibromyalgia syndrome and other central sensitivity syndromes. At the end of the article, the therapeutic implications of this new global and translational pathophysiological model will be briefly discussed.
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This updated guideline replaces the “Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science” first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline. This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.
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Introduction Clinical hypnosis has been proposed for post-surgical pain management for its potential vagal-mediated anti-inflammatory properties. Evidence is needed to understand its effectiveness for post-surgical recovery. Iin this secondary outcome study, it was hypothesized that surgical oncology patients randomized to receive perioperative clinical hypnosis (CH) would demonstrate greater heart-rate variability (HRV) during rest and relaxation at a 1-month post-surgery assessment compared to a treatment-as-usual group (TAU). Methods After REB approval, trial registration and informed consent, 92 participants were randomized to receive CH (n = 45) or TAU (n = 47). CH participants received a CH session before surgery and during post-surgical in-hospital stay HRV was assessed during rest (5 min) and relaxation (10 min) before and 1-month after surgery. Pain intensity was obtained using a 0–10 numeric rating scale pre and post 1-week and 1-month post surgery. Results One month after surgery, HRV was significantly higher in CH group (n = 29) during rest and relaxation (both p < 0.05, d = 0.73) than TAU group (n = 28). By contrast, rest and relaxation HRV decreased from pre- to 1-month post-surgery for the TAU (both p < 0.001, d > 0.48) but not the CH group. Pain intensity increased from pre-surgery to 1-week post-surgery (p < 0.001, d = 0.50), and decreased from 1-week to 1-month post-surgery (p = 0.005, d = 0.21) for all participants. Discussion The results suggest that hypnosis prevents the deleterious effects of surgery on HRV by preserving pre-operative vagal activity. These findings underscore the potential of clinical hypnosis in mitigating the adverse effects of surgery on autonomic function and may have significant implications for enhancing post-surgical recovery and pain management strategies. Clinical Trial Registration ClinicalTrials.gov, identifier (NCT03730350).
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Stress has been consistently linked to negative impacts on physical and mental health. More specifically, patients with chronic pain experience stress intolerance, which is an exacerbation or occurrence of symptoms in response to any type of stress. The pathophysiological mechanisms underlying this phenomenon remain unsolved. In this state-of-the-art paper, we summarised the role of the autonomic nervous system (ANS) and hypothalamus-pituitary-adrenal (HPA) axis, the two major stress response systems in stress intolerance. We provided insights into such mechanisms based on evidence from clinical studies in both patients with chronic pain, showing dysregulated stress systems, and healthy controls supported by preclinical studies, highlighting the link between these systems and symptoms of stress intolerance. Furthermore, we explored the possible regulating role for (epi)genetic mechanisms influencing the ANS and HPA axis. The link between stress and chronic pain has become an important area of research as it has the potential to inform the development of interventions to improve the quality of life for individuals living with chronic pain. As stress has become a prevalent concern in modern society, understanding the connection between stress, HPA axis, ANS, and chronic health conditions such as chronic pain is crucial to improve public health and well-being.
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A multisystem phenotype with the Triad of bodily pain, psychological distress, and sleep disturbance was found to have high risk for developing initial onset of painful temporomandibular disorders (TMDs) in the multicenter Orofacial Pain: Prospective Evaluation and Risk Assessment dataset. In this study, we systemically examined phenotypic characteristics and explored potential pathophysiology in quantitative sensory testing and autonomic nervous system domains in this multisystem Triad phenotype. Secondary analysis was performed on 1199 non-Triad and 154 Triad TMD-free Orofacial Pain: Prospective Evaluation and Risk Assessment enrollees at baseline. Results indicated that before developing TMDs, the Triad phenotype demonstrated both orofacial and systemic signs and symptoms that can only be captured through multisystem assessment. In addition, we found significantly lower resting heart rate variability and higher resting heart rate in the Triad phenotype as compared with the non-Triad group. However, pain sensitivity measured by quantitative sensory testing was not different between groups. These findings highlight the importance of whole-person multisystem assessment at the stage before developing complex pain conditions, such as TMDs, and suggest that, in addition to a "tissue damage monitor," pain should be considered in a broader context, such as a component within a "distress monitoring system" at the whole-person level when multisystem issues copresent. Therefore, the presence or absence of multisystem issues may carry critical information when searching for disease mechanisms and developing mechanism-based intervention and prevention strategies for TMDs and related pain conditions. Cardiovascular autonomic function should be further researched when multisystem issues copresent before developing TMDs.
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Introduction Chronic pain is a common symptom significantly affecting the quality of life of breast cancer survivors. Despite the achievement of pharmacological interventions, the barriers associated with this approach such as inaccessibility, misuse and side effects drive research into effective non-pharmacological interventions to improve chronic pain management, quality of life, anxiety and depression. Breathing exercise (BE) can be a promising option, but research evidence is sparse. This pilot study aims to examine the feasibility and preliminary effect of using an evidence-based BE intervention for chronic pain management in breast cancer survivors. Method and analysis This study will be a two-parallel-arm, open-labelled, phase II randomised controlled trial with 1:1 allocation. Seventy-two participants will be recruited from a tertiary hospital in China and randomly allocated to either a BE intervention group (n=36) or a control group (n=36). The participants in the intervention group will receive the usual care, a pain information booklet and a 4-week self-administered BE intervention; the participants in the control group will receive the usual care and the pain information booklet only. The assessment will be conducted at three time points: baseline (week 0), immediately after the intervention completion (week 5) and 4 weeks after the intervention completion (week 9). The primary outcomes will be the acceptability and feasibility assessment of the study protocol and methodological procedures. The secondary outcomes will be the effects of BE on pain, quality of life, anxiety and depression in breast cancer survivors. Descriptive statistics will be applied to present the primary outcomes and the Generalised Estimating Equation Model will be utilised to analyse the clinical outcomes. Ethics and dissemination This study has received ethical approvals from the Human Research Ethics Committee at Charles Darwin University (H21089) and the Clinical Trial Ethics Committee at the Affiliated Hospital of Southwest Medical University (KY2022107). Findings from this study will be presented at academic conferences and submitted to peer-reviewed journals for publication. Trial registration number ClinicalTrials.gov: NCT05257876 .
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Objectives Patients with psychosomatic disorders suffer from social isolation that might further lead to destabilization and exacerbation of bodily symptoms via autonomic pathways. We aimed to investigate the influence of controlled social stress (model of social ostracism) on the autonomic nerve system (ANS) in an inpatient cohort with psychosomatic disorders. Methods We examined heart rate variability (HRV), skin conductance (SC) and skin temperature (ST) as well as ECG-derived respiration rate (EDR) and subjective reports on stress during exposure to experimental social stress (cyberball game). Data were collected from 123 participants (f:m = 88:35, 42.01 ± 13.54 years) on admission and upon discharge from the university psychosomatic clinic. All data were recorded during baseline, inclusion and exclusion phases of the cyberball game as well as during the recovery phase. Results We found significant changes between admission and discharge with a decline in parasympathetic-related HRV parameters (SDRR −3.20 ± 1.30 ms, p = 0.026; RMSSD: −3.77 ± 1.28 ms, p = 0.007) as well as a decrease in SC (−0.04 ± 0.17 μS, p = 0.019) and EDR (−0.01 ± 0.01 Hz, p = 0.007), suggesting a drop in sympathetic tonus, with no changes in ST (p = 0.089) and subjective stress levels (p = 0.322). HRV parameters decreased during the cyberball game (SDRR p = 0.026; RMSSD p = 0.002; lnHF p < 0.001). In contrast, both SC (p < 0.001) and EDR (p < 0.001) increased during the game with SC being slightly lower during the exclusion phase. This can point toward a stimulation of sympathetic nervous system during game participation, which was concordant with the rise in subjective stress values (p < 0.001). ST showed a continuous, unspecific rise over time (p < 0.001). Conclusion Our data demonstrate the decrease of ANS parameters during experimental social stress when data upon discharge were compared to those upon admission. These results are partially contradictory to previous studies that showed a rise in HRV in a psychiatric cohort over the course of (outpatient) treatment. Further research is required to help attributing these differences to effects of treatment or acute states relating to admission to or discharge from a psychosomatic department.
Article
Background: Baseline heart rate variability (HRV) that reflects parasympathetic nervous system (PNS) activity may serve as an objective, physiological index of pain assessment, but more research is warranted to examine the link between HRV and laboratory pain responses. This study examined whether baseline HRV would predict pain responses to subsequent cold pressor test (CPT) in healthy adults. Methods: One hundred twenty-three participants completed resting HRV assessment and CPT consisting of immersing their right hand into a cold-water bath for a maximum of 2 minutes. Pain threshold and pain rating were assessed during CPT. Completion status of CPT, defined as completing CPT or terminating CPT before 2 minutes, was recorded as an additional laboratory pain measure. Pearson's correlation analysis was performed to examine the link between HRV and pain responses, whereas regression analysis was performed to test the prediction of pain responses via baseline HRV. Results: HF-HRVlog , which reflects PNS activity, was significantly associated with the CPT completion status (r = 0.23, p = 0.01), but not significantly associated with pain threshold (r = 0.17, p = 0.06) nor pain rating (r = -0.11, p = 0.24). HF- HRVlog was found to be a significant predictor of the CPT completion status (B = 0.53, p = 0.013). Conclusions: Baseline HF- HRVlog may serve as an objective, physiological index to predict laboratory pain responses, and completion status of laboratory pain tests, such as CPT, may be used as a laboratory pain measure to capture important individual differences in pain processing.
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Introduction: Chronic pain (CP) patients often display lower heart rate variability (HRV) and baroreceptor sensitivity (BRS), which are associated with increased evoked pain intensity and decreased pain tolerance. Objective: The purpose of this study was to test whether the association between low levels of HRV and BRS and increased evoked pain responsiveness in individuals with CP is mediated by psychological distress and whether this mediation is sex dependent. Methods: The sample consisted of 877 participants in Wave 6 of the Tromsø population study who reported clinically meaningful CP. Resting HRV and BRS parameters were derived from continuous beat-to-beat blood pressure recordings. Psychological distress was assessed using the Hopkins Symptom Checklist-10. After cardiovascular assessment, participants completed a 106-second cold pressor task (3°C bath), which assessed cold pressor pain intensity (CPI) and cold pressor pain tolerance (CPT). Results: In the full CP sample, mediation analyses showed significant indirect effects, without direct effects, of HRV and BRS on both CPT and CPI via psychological distress. When stratified by sex, significant indirect effects via psychological distress were only found in males for the impact of rMSSD on CPT, the impact of SDNN on CPT, and the impact of BRS on CPT via psychological distress. Moderated mediation analyses revealed that there were no significant sex differences in the indirect effects of HRV and BRS on both CPT and CPI via psychological distress. Conclusions: The hypoalgesic impact of cardiovascular regulatory systems on evoked pain responses is conveyed via the indirect effects of psychological distress.
Thesis
Le stress est un enjeu majeur de santé public, responsable du développement et de l’aggravation d’un grand nombre de troubles somatiques (maladies cardio-vasculaires,cancers, maladies infectieuses …) et psychiatriques (anxiété, dépression …). La gestion du stress par les thérapies comportementales, cognitives et émotionnelles (TCCE) est efficace pour réduire les conséquences négatives du stress et prévenir les troubles chez les sujets àrisque, mais son accès reste limité. Internet et les nouvelles technologies du numérique,notamment les self-help, les e-TCC et le biofeedback de variabilité de fréquence cardiaque(biofeedback de VFC) peuvent enrichir les programmes de gestion du stress par les TCCEet faciliter leur accès. Dans ce contexte, l’objectif de ce travail de thèse était de développeret d’évaluer des formats de traitements novateurs combinant TCCE et nouvellestechnologies.Dans un premier temps, le programme Seren@ctif, premier programme francophone de e-TCC dédié à la gestion du stress, a fait l’objet d’un essai contrôlé randomisé sur 120patients répondant au diagnostic de trouble d’adaptation avec anxiété (TAA) selon lescritères du DSM-5 et venant consulter en service de psychiatrie ambulatoire du CHU deLille. Les résultats ont mis en évidence que la TCCE administrée sur internet et guidée parun temps de contact humain en face-à-face avec un professionnel de santé supervisé(TCCE mixte) est tout aussi efficace que la TCCE entièrement administrée en face-à-facepour le traitement du TAA, par comparaison à un groupe contrôle de patients bénéficiantd’un suivi habituel par leur médecin généraliste.Dans un second temps, un nouveau biofeedback de VFC directement basé sur l’activationvagale, a été élaboré à partir d’une nouvelle mesure d’activation parasympathiquedéveloppée par l’équipe du centre d’investigation clinique, innovations technologiques deLille. Cette thèse présente les étapes d’élaboration de ce nouveau biofeedback, suiviesd’une preuve de concept portant sur plusieurs patients présentant divers troubles anxieuxet dépressifs. Ce nouveau biofeedback de VFC constitue une approche prometteusepermettant de stimuler de manière non-invasive le nerf vague. Il pourrait permettreégalement d’améliorer durablement l’activation vagale et d’objectiver physiologiquementl’effet bénéfique de la Mindful Breathing. Cette approche pourrait être complémentaire autraditionnel biofeedback d’arythmie sinusale respiratoire et permettrait de diversifier lestechniques comportementales associées au biofeedback.Les recherches présentées dans cette thèse contribuent à faire avancer la recherche dans ledomaine des technologies de l’information appliquées à la santé mentale etcomportementale. Elles ouvrent des perspectives innovantes sur une nouvelle façond’administrer les TCCE sur internet, sur l’efficacité potentielle d’un nouveau biofeedbackde VFC, ou encore, sur l’intérêt d’un nouveau marqueur de flexibilité du système nerveuxautonome dans l’évaluation objective de l’efficacité des TCC de troisième vague, notammentla Mindfulness
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Objectives In patients with chronic pain, a relative lower parasympathetic activity is suggested based on heart rate variability measurements. It is hypothesized that spinal cord stimulation (SCS) is able to influence the autonomic nervous system. The aim of this study is to further explore the influence of SCS on the autonomic nervous system by evaluating whether SCS is able to influence skin conductance, blood volume pulse, heart rate, and respiration rate. Materials and Methods Twenty‐eight patients with Failed Back Surgery Syndrome (FBSS), who are treated with SCS, took part in this multicenter study. Skin conductance and cardiorespiratory parameters (blood volume pulse, heart rate, and respiration rate) were measured during on and off states of SCS. Paired statistics were performed on a 5‐min recording segment for all parameters. Results SCS significantly decreased back and leg pain intensity scores in patients with FBSS. Skin conductance level and blood volume pulse were not altered between on and off states of SCS. Heart rate and respiration rate significantly decreased when SCS was activated. Conclusions Parameters that are regulated by the sympathetic nervous system were not significantly different between SCS on and off states, leading to the hypothesis that SCS is capable of restoring the dysregulation of the autonomic nervous system by primarily increasing the activity of the parasympathetic system, in patients with FBSS.
Chapter
The analysis of heart rate variability (HRV) has been established in the last decades. HRV is a global indicator of the status of the autonomic nervous system. It is con-trolled by several regulatory circuits and influenced by confounders. Reference val-ues are helpful, but confounders shall be considered for a correct interpretation of the HRV analysis. Based on international guidelines and published reviews this man-uscript describes the important confounders. Basically, the confounders can be sorted in four main groups: non-influenceable physiological parameters (e.g. age, circadian rhythm, gender, genetics), diseases (e.g. metabolic diseases, heart dis-eases, psychiatric diseases), influenceable lifestyle factors (e.g. physical fitness, sporting activities, increased body weight, smoking, alcohol abuse) and external fac-tors (e.g. noise, night shift work, harmful substances). Nearly all factors reduce the HRV, only positive associated lifestyle factors (e.g. a higher physical activity, non-smoking) are correlated with a higher HRV. The knowledge of this confounders is necessary for a correct interpretation of the HRV and should be take into consider every time a HRV analysis is done.
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Background Orofacial pain has a broad range of origins and a multidisciplinary approach occupies a relevant role. Objective The aim of this study was to review the literature regarding the evolution of telemedicine and orofacial pain related to a case report of a patient affected by Eagle's syndrome. Materials and Methods Two authors (RJM and SG) independently reviewed the literature up to March 2020. A case report was developed by including the interdisciplinary assessment and initial treatment of orofacial pain in a 38-year-old female patient affected by Eagle’s syndrome. The patient was interviewed by two different specialists (from Rome, Italy and Los Angeles, California) through an online meeting platform in order to evaluate her complex situation, demonstrating the possibilities that telemedicine offered during the COVID-19 pandemic. Conclusion An interdisciplinary approach can be performed for future follow ups on patients as various advantages were found by the patient and by the clinicians themselves.
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Resting blood pressure (BP) and heart rate variability (HRV) are linked to physical pain. Research also shows a link between social pain and physical pain, and an inverse association between resting BP and social pain. However, little is known regarding the relationship between resting HRV and social pain. Therefore, the present study aimed to replicate the link between social pain and physical pain, and the inverse relationship between resting BP and social pain, and explore the relationship between resting HRV and social pain. One-hundred twenty three healthy adults completed 1) resting cardiovascular measurements of BP and low-frequency (LF) and high-frequency (HF) HRV powers, 2) social pain sensitivity assessment via the Brief Fear of Negative Evaluation (BFNE) and Mehrabian's Sensitivity to Rejection (MSR) scales, and 3) physical pain sensitivity assessment via subjective pain responses during cold pressor test. The results indicated that no association was observed between social pain and physical pain, whereas resting BP was inversely associated with the MSR scores. Resting LF-HRV was inversely associated with social pain, whereas resting HF-HRV was positively associated with social pain. These findings suggest that physical pain and social pain may share biological substrates that are involved in BP regulation and pain control.
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Results: The methods' heart rate variability and electroencephalogram show clear and consistent results as acute pain assessment. Magnetic resonance imaging can measure chronic pain. Ordered by invasiveness and vulnerability, a trend shows that the invasive methods are used more with less vulnerable subjects. Only instruments used for skin conductance and automatic facial recognition have a lower-than-average technological maturity. Conclusions: Some pain assessment methods show good and consistent results and have high technological maturity; however, using them as pain assessment for persons with ID is uncommon. Since this addition can ameliorate caregiving, more research of assessment methods should occur.
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The R environment provides a natural platform for developing new statistical methods due to the mathematical expressiveness of the language, the large number of existing libraries, and the active developer community. One drawback to R, however, is the learning curve; programming is a deterrent to non-technical users, who typically prefer graphical user interfaces (GUIs) to command line environments. Thus, while statisticians develop new methods in R, practitioners are often behind in terms of the statistical techniques they use as they rely on GUI applications. Meta-analysis is an instructive example; cutting-edge meta-analysis methods are often ignored by the overwhelming majority of practitioners, in part because they have no easy way of applying them. This paper proposes a strategy to close the gap between the statistical state-of-the-science and what is applied in practice. We present open-source meta-analysis software that uses R as the underlying statistical engine, and Python for the GUI. We present a framework that allows methodologists to implement new methods in R that are then automatically integrated into the GUI for use by end-users, so long as the programmer conforms to our interface. Such an approach allows an intuitive interface for non-technical users while leveraging the latest advanced statistical methods implemented by methodologists.
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Rumination is a form of thought characterized by repetitive focus on discomforting emotions or stimuli. In chronic pain disorders, rumination can impede treatment efficacy. The brain mechanisms underlying rumination about chronic pain are not understood. Interestingly, a link between rumination and functional connectivity (FC) of the brain's default mode network (DMN) has been identified within the context of mood disorders. We, and others, have also found DMN dysfunction in chronic pain populations. The medial prefrontal cortex (mPFC) is a key node of the DMN that is anatomically connected with the descending pain modulatory system. Therefore, we tested the hypothesis that in patients with chronic pain, the mPFC exhibits abnormal FC related to the patient's degree of rumination about their pain. Seventeen patients with idiopathic temporomandibular disorder (TMD) and 17 age- and sex-matched healthy controls underwent resting state functional MRI, and rumination about pain was assessed through the rumination subscale of the Pain Catastrophizing Scale. Compared with healthy controls, we found that TMD patients exhibited enhanced mPFC FC with other DMN regions, including the posterior cingulate cortex (PCC)/precuneus (PCu) and retrosplenial cortex. We also found that individual differences in pain rumination in the chronic pain patients (but not in healthy controls) were positively correlated to mPFC FC with the PCC/PCu, retrosplenial cortex, medial thalamus, and periaqueductal/periventricular gray. These data implicate communication within the DMN and of the DMN with the descending modulatory system as a mechanism underlying the degree to which patients ruminate about their chronic pain.
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As in many fields of neuroscience, alterations in brain morphology, and specifically gray matter volume and cortical thickness, have been repeatedly linked to chronic pain disorders. Numerous studies have shown changes in cortical and subcortical brain regions suggesting a dynamic process that may be a result of chronic pain or contributing to a more generalized phenomenon in chronic pain including comorbid anxiety and depression. In this review, we provide a perspective of pain as an innate state of pain based on alterations in structure and by inference, brain function. A better neurobiological understanding of gray matter changes will contribute to our understanding of how structural changes contribute to chronic pain (disease driver) and how these changes may be reversed (disease modification or treatment).
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Neck-shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation in relation to physical activity and perceived symptoms during work and leisure time among workers with chronic NSP (n = 29) as compared to a healthy control group (CON, n = 27). Physical activity was objectively monitored for 7 days using accelerometry. Beat-to-beat heart rate was collected continuously for 72 h, with simultaneous momentary ratings of pain, stress, and fatigue. Duration of sitting/lying, standing and walking, number of steps, and energy expenditure were used as measures of physical activity. Heart rate variability (HRV) indices were extracted in time and frequency domains as reflecting autonomic regulation. Data were divided into work hours, leisure time, and sleep. The NSP group rated higher levels of stress and fatigue at work and leisure, and reduced sleep quality as compared to CON. Elevated heart rate and reduced HRV were found in NSP compared with CON, especially during sleep. The NSP group demonstrated a different pattern of physical activity than CON, with a lower activity level in leisure time. Higher physical activity was associated with increased HRV in both groups. Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP.
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Sleep is a physiological process involving different biological systems, from molecular to organ level; its integrity is essential for maintaining health and homeostasis in human beings. Although in the past sleep has been considered a state of quiet, experimental and clinical evidences suggest a noteworthy activation of different biological systems during sleep. A key role is played by the autonomic nervous system (ANS), whose modulation regulates cardiovascular functions during sleep onset and different sleep stages. Therefore, an interest on the evaluation of autonomic cardiovascular control in health and disease is growing by means of linear and non-linear heart rate variability (HRV) analyses. The application of classical tools for ANS analysis, such as HRV during physiological sleep, showed that the rapid eye movement (REM) stage is characterized by a likely sympathetic predominance associated with a vagal withdrawal, while the opposite trend is observed during non-REM sleep. More recently, the use of non-linear tools, such as entropy-derived indices, have provided new insight on the cardiac autonomic regulation, revealing for instance changes in the cardiovascular complexity during REM sleep, supporting the hypothesis of a reduced capability of the cardiovascular system to deal with stress challenges. Interestingly, different HRV tools have been applied to characterize autonomic cardiac control in different pathological conditions, from neurological sleep disorders to sleep disordered breathing (SDB). In summary, linear and non-linear analysis of HRV are reliable approaches to assess changes of autonomic cardiac modulation during sleep both in health and diseases. The use of these tools could provide important information of clinical and prognostic relevance.
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Chronic pain conditions are associated with abnormalities in brain structure and function. Moreover, some studies indicate that brain activity related to the subjective perception of chronic pain may be distinct from activity for acute pain. However, the latter are based on observations from cross-sectional studies. How brain activity reorganizes with transition from acute to chronic pain has remained unexplored. Here we study this transition by examining brain activity for rating fluctuations of back pain magnitude. First we compared back pain-related brain activity between subjects who have had the condition for ∼2 months with no prior history of back pain for 1 year (early, acute/subacute back pain group, n = 94), to subjects who have lived with back pain for >10 years (chronic back pain group, n = 59). In a subset of subacute back pain patients, we followed brain activity for back pain longitudinally over a 1-year period, and compared brain activity between those who recover (recovered acute/sub-acute back pain group, n = 19) and those in which the back pain persists (persistent acute/sub-acute back pain group, n = 20; based on a 20% decrease in intensity of back pain in 1 year). We report results in relation to meta-analytic probabilistic maps related to the terms pain, emotion, and reward (each map is based on >200 brain imaging studies, derived from neurosynth.org). We observed that brain activity for back pain in the early, acute/subacute back pain group is limited to regions involved in acute pain, whereas in the chronic back pain group, activity is confined to emotion-related circuitry. Reward circuitry was equally represented in both groups. In the recovered acute/subacute back pain group, brain activity diminished in time, whereas in the persistent acute/subacute back pain group, activity diminished in acute pain regions, increased in emotion-related circuitry, and remained unchanged in reward circuitry. The results demonstrate that brain representation for a constant percept, back pain, can undergo large-scale shifts in brain activity with the transition to chronic pain. These observations challenge long-standing theoretical concepts regarding brain and mind relationships, as well as provide important novel insights regarding definitions and mechanisms of chronic pain.
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To analyze autonomic nervous system activity in headache subjects, measurements of heart rate variability (HRV), skin temperature, skin conductance, and respiration were compared to a matched control group. HRV data were recorded in time and frequency domains. Subjects also completed self-report questionnaires assessing psychological distress, fatigue, and sleep dysfunction. Twenty-one headache and nineteen control subjects participated. In the time domain, the number of consecutive R-to-R intervals that varied by more than 50 ms and the standard deviation of the normalized R-to-R intervals, both indices of parasympathetic nervous system activity, were significantly lower in the headache group than the control group. Groups did not differ statistically on HRV measures in the frequency domain. Self-report measures showed significantly increased somatization, hostility, anxiety, symptom distress, fatigue, and sleep problems in the headache group. The results suggest headache subjects have increased sympathetic nervous system activity and decreased parasympathetic activity compared to non-headache control subjects. Headaches subjects also showed greater emotional distress, fatigue, and sleep problems. The results indicate an association between headaches and cardiovascular functioning suggestive of sympathetic nervous system activation in this sample of mixed migraine and tension-type headache sufferers.
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Many experimental and clinical studies have confirmed a continuous cross-talk between both sympathetic and parasympathetic branches of autonomic nervous system and inflammatory response, in different clinical scenarios. In cardiovascular diseases, inflammation has been proven to play a pivotal role in disease progression, pathogenesis and resolution. A few clinical studies have assessed the possible inter-relation between neuro-autonomic output, estimated with heart rate variability analysis, which is the variability of R-R in the electrocardiogram, and different inflammatory biomarkers, in patients suffering from stable or unstable coronary artery disease (CAD) and heart failure. Moreover, different indices derived from heart rate signals' processing, have been proven to correlate strongly with severity of heart disease and predict final outcome. In this review article we will summarize major findings from different investigators, evaluating neuro-immunological interactions through heart rate variability analysis, in different groups of cardiovascular patients. We suggest that markers originating from variability analysis of heart rate signals seem to be related to inflammatory biomarkers. However, a lot of open questions remain to be addressed, regarding the existence of a true association between heart rate variability and autonomic nervous system output or its adoption for risk stratification and therapeutic monitoring at the bedside. Finally, potential therapeutic implications will be discussed, leading to autonomic balance restoration in relation with inflammatory control.
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Studies in adults have demonstrated a relationship between lowered heart rate variability (HRV) and poor health. However, less is known about the role of autonomic arousal in children’s well-being. The aim of the current study was to examine resting HRV in children with chronic pain compared to healthy control children and, further, to examine children’s HRV following a series of acute experimental pain tasks in both groups. Participants included 104 healthy control children and 48 children with chronic pain aged 8–17 years. The laboratory session involved a 5-minute baseline electrocardiogram followed by four pain induction tasks: evoked pressure, cold pressor, focal pressure, and a conditioned pain modulation task. After the tasks were complete, a 5-minute post-task electrocardiogram recording was taken. Spectral analysis was used to capture high-frequency normalized power and the ratio of low-to-high frequency band power, signifying cardiac vagal tone and sympathetic balance, respectively. Results revealed that children with chronic pain had significantly lower resting HRV (signified by low high-frequency normalized power and high ratio of low-to-high frequency band power) compared to healthy children; moreover, a significant interaction between groups and time revealed that children with chronic pain displayed a static HRV response to the pain session compared to healthy children, whose HRV was reduced concomitant with the pain session. These findings suggest that children with chronic pain may have a sustained stress response with minimal variability in response to new acute pain stressors.
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Background: Patients with chronic whiplash associated disorders (WAD) demonstrate altered central pain processing and impaired endogenous analgesia. In addition, previous research reported disturbances in the autonomic nervous system and the presence of post-traumatic stress reaction in patients with chronic WAD. The autonomic nervous system, in particular the autonomic stress response, might modulate central pain processing in this population. Objectives: The goal of this study was to compare the autonomic response to acute painful stimuli in patients with chronic WAD and healthy controls and to look for associations between endogenous analgesia and autonomic parameters. Study design: Case-control study. Methods: Thirty patients with chronic WAD and 31 healthy controls were subjected to an experiment evaluating the autonomic nervous system at rest and during experimental painful stimuli. Skin conductance, heart rate, and heart rate variability parameters were monitored continuously during the evaluation of conditioned pain modulation. The paradigm of heterotopic noxious conditioning stimulation was used to assess this conditioned pain modulation effect. Results: The data revealed no difference in autonomic response to pain between chronic WAD and healthy controls. The autonomic response was unrelated to pressure pain thresholds or the effect of conditioned pain modulation in either group. Limitations: The present study only investigates the autonomic response to a stress caused by pain. Conclusion: Results of this study refute autonomic dysfunction in response to pain in patients with chronic WAD. The autonomic nervous system activity or reactivity to acute pain appears unrelated to either pain thresholds or endogenous analgesia in patients with chronic WAD.
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Background A chronic pain condition may result in altered autonomic nervous system regulation in various patient populations. We evaluated whether autonomic regulation differs between sciatica patients referred to spine surgery and age-matched healthy controls analyzed with heart rate variability techniques (HRV). Methods HRV of patients (n = 201) and healthy controls (n = 138) were measured in standing conditions (5 min). High frequency (HF) power as an index of cardiac vagal modulation and the low-to-high-frequency (LF/HF) ratio and short-term fractal scaling exponent α1 as indices of sympathovagal balance were analyzed. Pain intensity was assessed on a Visual Analog Scale (VAS) and perceived disability with Oswestry Disability Index. Results The Oswestry and VAS scores were higher in the patients than in the controls (p < 0.0001 for both). HF power was markedly lower for the patients compared to the controls (p < 0.0001). The LF/HF ratio and α1 were higher in the patients than in the controls (p < 0.01 for both). After adjusting for sex, smoking, BMI, and leisure-time physical activity, HF power (p = 0.011) and α1 (p = 0.012) still differed between the groups. Among the patients, HF power was slightly associated with the duration of chronic pain (r = −.232, p = 0.003). Conclusions Sciatica patients referred to spine surgery had altered cardiac autonomic regulation expressed as decreased vagal activity and an increased sympathovagal balance toward sympathetic dominance when compared with age-matched healthy controls.
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Objectives: To investigate heart rate variability (HRV) in fibromyalgia (FM) patients and healthy controls (HCs) during different sleep stages, and to examine the association of HRV with pain and sleep quality. Method: Polysomnography was recorded from 23 female FM patients and 22 age- and sex-matched HCs. HRV was recorded from bedtime until awakening including the standard deviation of normal-to-normal intervals (SDNN), the root mean square successive difference (RMSSD), and the low (LF; 0.04-0.15 Hz) and high (HF; 0.15-0.4 Hz) frequency power. Subjective scores of neck/shoulder pain and sleep quality were obtained at bedtime and awakening. Results: Both patients and HCs showed high incidence of arousals per hour (FM: 16 ± 9.7; HCs: 17 ± 11). RMSSD was lower in patients than HCs during non-rapid eye movement (non-REM) stage 2 (N2) sleep (mean ± SD; 30 ± 12 ms vs. 42 ± 13 ms, p < 0.002) and during REM sleep (23 ± 11 ms vs. 37 ± 16 ms, p < 0.003). HRV did not differ between groups during N3 sleep (p > 0.19 for all comparisons). In patients, SDNN, RMSSD, and HF power showed modest positive correlations with sleep quality (HF power during N3 sleep showed the highest correlation; Spearman's ρ = 0.54) and modest negative correlations with neck/shoulder pain (RMSSD during N3 sleep showed the highest correlation with pain at bedtime; Spearman's ρ = -0.51). Conclusions: RMSSD, indicative of parasympathetic predominance, is attenuated in FM patients compared to HCs during N2 sleep and REM sleep. This difference was not present for the HF component. HRV during sleep in FM patients is moderately and positively associated with sleep quality and moderately and negatively associated with neck/shoulder pain.
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The study of individual differences in emotional responding can provide considerable insight into interpersonal dynamics and the etiology of psychopathology. Heart rate variability (HRV) analysis is emerging as an objective measure of regulated emotional responding (generating emotional responses of appropriate timing and magnitude). This review provides a theoretical and empirical rationale for the use of HRV as an index of individual differences in regulated emotional responding. Two major theoretical frameworks that articulate the role of HRV in emotional responding are presented, and relevant empirical literature is reviewed. The case is made that HRV is an accessible research tool that can increase the understanding of emotion in social and psychopathological processes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The main mechanism underlying irritable bowel syndrome is currently believed to be a dysfunction of the brain-gut axis. Autonomic nervous system dysfunction can contribute to development of irritable bowel syndrome symptoms by disturbing visceral sensations. Thirty patients with a diagnosis of constipation-predominant irritable bowel syndrome and 30 healthy volunteers were included in the study. Resting and functional autonomic nervous system tests and percutaneous electrogastrography were performed. Plasma adrenalin, noradrenalin, insulin, ghrelin and cholecystokinin activity was analyzed. Increased sympathetic activation with disturbed parasympathetic function was demonstrated. Patients had substantially higher plasma catecholamine concentration, which confirms sympathetic overbalance. Hyperinsulinemia may explain sympathetic predominance followed by gastric and intestinal motility deceleration. Abnormal, reduced ghrelin and cholecystokinin titre may disturb brain-gut axis functioning and may be responsible for gastric motility deceleration. In electrogastrography, distinctly lower values of fasting normogastria percentage and dominant power were observed. Patients had substantially lower slow wave coupling percentage both in fasting and postprandial periods, which negatively correlated with plasma catecholamines level. Gastric myoelectrical activity disturbances may result from lack of sympatho-parasympathetic equilibrium. Central sympathetic influence within the brain-gut axis is most probably responsible for myoelectrical activity disturbances in irritable bowel syndrome patients.
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To identify the basic values of heart rate variability in Pakistani population and to verify our hypothesis that there are gender differences in cardiovascular autonomic modulation. The descriptive cross sectional study based on convenience probability sampling was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Pakistan. The duration of the study was from December 2009 to July 2010. It involved 24-hour holter monitoring of 45 healthy individuals using holter electrocardiography (ECG) recorder. Heart rate variability was analysed in time (SDNN, SDANN, SDNNi, rMSSD, pNN50) and frequency domains (power, VLF, LF, and HF). The time domain indices; SDNN (male = 140 +/- 36ms vs. females = 122 +/- 33ms; p = 0.09), SDANN (male = 123 +/- 34ms vs. females = 111 +/- 34ms; P = 0.23), SDNNi (male = 64 +/- 19ms vs. females = 52 +/- 14ms; P = 0.03), and pNN50 (male = 14 +/- l0ms vs. females = 12 +/- 7ms; P = 0.43) were decreased in female volunteers when compared with males. Comparison of frequency domain indices; Total power (male = 4041 +/- 3150ms(2) vs. females = 2750 +/- 1439ms(2); P = 0.07), VLF (male = 2912 +/- 2675ms(2) vs. females = 1843 +/- 928ms(2); P = 0.06), LF (male = 788 +/- 397ms(2) vs. females = 556 +/- 346ms(2); P = 0.04) and HF (male = 318 +/- 251ms(2) vs. females = 312 +/- 277ms(2): P = 0.94) amongst males and females showed attenuated heart rate variability in females. Of all the observed values, SDNNi and LF were found significantly (p < 0.05) decreased in women. In healthy population, heart rate variability is low in women than men. It reflects sympathetic dominance in women in our population.
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The neurovisceral integration model (Thayer, J. F., & Lane, R. D., 2000, A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61, 201-216. doi:10.1016/S0165-0327(00)00338-4) proposes that individual differences in heart rate variability (HRV)-an index of cardiac vagal tone-are associated with attentional and emotional self-regulation. In this article, we demonstrate that individual differences in resting HRV predict the functioning of the inhibition of return (IOR), an inhibitory attentional mechanism highly adaptive to novelty search, in response to affectively significant face cues. As predicted, participants with lower HRV exhibited a smaller IOR effect to fearful versus neutral face cues than participants with higher HRV, which shows a failure to inhibit attention from affectively significant cues and instigate novelty search. In contrast, participants with higher HRV exhibited similar IOR effects to fearful and neutral face cues, which shows an ability to inhibit attention from cues and instigate novelty search. Their ability to inhibit attention was most pronounced to high spatial frequency fearful face cues, suggesting that this effect may be mediated by cortical mechanisms. The current research demonstrates that individual differences in HRV predict attentional inhibition and suggests that successful inhibition and novelty search may be mediated by cortical inhibitory mechanisms among people with high cardiac vagal tone. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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Objectives: The vagus nerve influences the modulation of pain. Chronic pain is associated with disturbance of the descendent inhibitory pathway (DIP). Heart rate variability (HRV) is a proxy measure for vagal activity and may reflect dysfunction of the DIP. We aimed to investigate the association of HRV and pain in individuals with and without chronic pain. Methods: Drawing on cross-sectional data from 647 individuals, the present study explores the association of HRV and pain. The root mean square of successive differences (RMSSD), corresponding to parasympathetic regulation of the heart, was derived from 24-hour ECG recordings. Pain, demographic data and health behaviors were assessed by self-administered questionnaires. Blood pressure was measured and inflammatory markers (white blood cell count, C-reactive protein, and Fibrinogen) were analyzed from fasting blood samples. Results: Those with chronic pain reported lower RMSSD. Results revealed a negative correlation of HRV and pain in multivariate adjusted analysis, only in respondents without chronic pain. Discussion: Our results suggest, that the DIP indexed by vagal activity operationalized as RMSSD is disturbed in persons with chronic pain. Furthermore, the correlations between RMSSD and pain are different between those without and those with chronic pain. The findings are discussed, emphasizing changes in brain activity and the comorbid dysregulation of emotion in patients with chronic pain, to provide implications for the treatment of chronic pain.
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Background: Ethnic disparities in cardiovascular morbidity and mortality are widely documented in the literature. Recently, research has shown that decreased parasympathetic cardiac modulation is associated with the established and emerging risk factors for cardiovascular disease (CVD) and stroke. In consideration of the disproportionate CVD risk and disease profile of African Americans (AAs), it is plausible that decreased cardiac parasympathetic functioning may partially explain these disparities. In the present systematic review and meta-analysis, we assess the available evidence for a reliable ethnic difference in tonic vagally mediated heart rate variability (HRV), an indicator of parasympathetic cardiac modulation. Methods: A systematic literature search was conducted yielding studies comparing tonic HRV in AAs and European Americans. Adjusted standardized effect sizes (Hedges g) were calculated using a mixed-effects model, with restricted maximum likelihood estimation for 17 studies containing appropriate measures of vagally mediated HRV. Results: Meta-analysis results suggest that AAs have greater HRV than do European Americans (Hedges g = 0.93, 95% confidence interval = 0.25-1.62), even after consideration of several covariates including health status, medication use, and subgroup stratification by sex and age. Conclusions: These findings suggest that decreased vagally mediated HRV is not likely to account for the persistent health disparities experienced by AAs with respect to CVD risk and burden. These disparities underscore the need for continued research addressing socioethnic cardiovascular differences and the biobehavioral mechanisms involved.
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Background: Inflammation and vagally mediated heart rate variability (vmHRV) have been implicated in a number of conditions including diabetes and cardiovascular disease. Consistent with the inflammatory reflex termed the “cholinergic anti-inflammatory pathway”, numerous cross-sectional studies have demonstrated negative associations between vmHRV and inflammatory markers such as C-reactive protein (CRP). The only prospective study, however, showed the opposite: higher CRP at baseline predicted higher high-frequency heart rate variability (HF-HRV) at follow-up. Thus additional studies are needed to examine the prospective association between vmHRV and CRP. Methods: Healthy employees participated in a voluntary on-site health assessment. Blood samples and ambulatory heart rate recordings were obtained, and night-time HF-HRV was calculated. Useable heart rate data were available in 2007 for 106 non-smoking employees (9% women; age 44.4±8 years), all of whom returned for an identical follow-up health assessment in 2011. Bootstrapped (500 replications) bivariate (r) and partial Pearson's correlations (ppc) adjusting for sex, age and body mass index at baseline (2007) were calculated. Results: Zero-order correlations indicated that higher HF-HRV was associated with lower levels of CRP at both timepoints (2007: r = –0.19, P < 0.05; 2011: r = –0.34, P < 0.001). After adjustment, HF-HRV remained a significant predictor of CRP (ppc = –0.20, P < 0.05). Conclusion: In the present study we have provided in vivo support for the cholinergic anti-inflammatory pathway in humans. Cardiac vagal modulation at baseline predicts level of CRP 4 years later. Our findings have important implications for the role of vmHRV as a risk factor for cardiovascular disease morbidity and mortality. Interventions targeted at vmHRV might be useful in the prevention of diseases associated with elevated systemic inflammation.
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Fibromyalgia often coexists and overlaps with other syndromes such as chronic fatigue, irritable bowel syndrome, and interstitial cystitis. Chronic stress has been implicated in the pathogenesis of these illnesses. The sympathetic nervous system is a key element of the stress response system. Sympathetic dysfunction has been reported in these syndromes, raising the possibility that such dysautonomia could be their common clustering underlying pathogenesis. The objective of this study was to carry out a review of all published comparative case-control studies investigating sympathetic nervous system performance in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. Online databases PubMed and EMBASE were accessed using the following key words: autonomic (OR) sympathetic (AND) fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. All entries up to December 10th 2012 were reviewed by 2 independent investigators searching for case-control studies in humans. The Method for Evaluating Research and Guidelines Evidence adapted to the Scottish Intercollegiate Guidelines Network was used to rank the level of evidence contained in the selected articles. A total of 196 articles are included in this review. The most often used methods to assess sympathetic functionality were heart rate variability analysis, sympathetic skin response, tilt table testing, and genetic studies. The majority of studies (65%) described sympathetic nervous system predominance in these overlapping syndromes. In contrast, 7% of the studies found parasympathetic predominance. This review demonstrates that sympathetic nervous system predominance is common in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. This concordance raises the possibility that sympathetic dysfunction could be their common underlying pathogenesis that brings on overlapping clinical features. The recognition of sympathetic predominance in these 4 syndromes may have potential clinical implications. It may be worth exploring the use of nonpharmacological measures as well as drug therapies aimed to regain autonomic balance.