1
|
Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
Collapse
Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
2
|
Aziz S, Khan MU, Hirachan N, Chetty G, Goecke R, Fernandez-Rojas R. "Where does it hurt?": Exploring EDA Signals to Detect and Localise Acute Pain. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083346 DOI: 10.1109/embc40787.2023.10341157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pain is a highly unpleasant sensory experience, for which currently no objective diagnostic test exists to measure it. Identification and localisation of pain, where the subject is unable to communicate, is a key step in enhancing therapeutic outcomes. Numerous studies have been conducted to categorise pain, but no reliable conclusion has been achieved. This is the first study that aims to show a strict relation between Electrodermal Activity (EDA) signal features and the presence of pain and to clarify the relation of classified signals to the location of the pain. For that purpose, EDA signals were recorded from 28 healthy subjects by inducing electrical pain at two anatomical locations (hand and forearm) of each subject. The EDA data were preprocessed with a Discrete Wavelet Transform to remove any irrelevant information. Chi-square feature selection was used to select features extracted from three domains: time, frequency, and cepstrum. The final feature vector was fed to a pool of classification schemes where an Artificial Neural Network classifier performed best. The proposed method, evaluated through leave-one-subject-out cross-validation, provided 90% accuracy in pain detection (no pain vs. pain), whereas the pain localisation experiment (hand pain vs. forearm pain) achieved 66.67% accuracy.Clinical relevance- This is the first study to provide an analysis of EDA signals in finding the source of the pain. This research explores the viability of using EDA for pain localisation, which may be helpful in the treatment of noncommunicable patients.
Collapse
|
3
|
Roles of Heart Rate Variability in Assessing Autonomic Nervous System in Functional Gastrointestinal Disorders: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13020293. [PMID: 36673103 PMCID: PMC9857852 DOI: 10.3390/diagnostics13020293] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Functional gastrointestinal disorders (FGID) and gastroesophageal reflux (GERD) disease affect a large global population and incur substantial health care costs. Impairment in gut-brain communication is one of the main causes of these disorders. The central nervous system (CNS) provides its inputs to the enteric nervous system (ENS) by modulating the autonomic nervous system (ANS) to control the gastrointestinal functions. Therefore, GERD and FGID's might be associated with autonomic dysfunction, which can be identified via heart rate variability (HRV). FGIDs may be treated by restoring the autonomic dysfunction via neuromodulation. This article reviews the roles of HRV in the assessment of autonomic function and dysfunction in (i) gastroesophageal reflux (GERD), and the following FGIDs: (ii) functional dyspepsia (FD) and gastroparesis, (iii) irritable bowel syndrome (IBS) and (iv) constipation. The roles of HRV in the assessment of autonomic responses to various interventions were also reviewed. We used PUBMED, Web of Science, Elsevier/Science direct and Scopus to search the eligible studies for each disorder, which also included the keyword 'heart rate variability'. The retrieved studies were screened and filtered to identify the most suitable studies using HRV parameters to associate the autonomic function with any of the above disorders. Studies involving both human and animal models were included. Based on analyses of HRV, GERD as well as the FGIDs were found to be associated with decreased parasympathetic activity and increased sympathetic nervous system activity with the autonomic balance shifted towards the sympathetic nervous system. In addition, the HRV methods were also reported to be able to assess the autonomic responses to various interventions (mostly neuromodulation), typically the enhancement of parasympathetic activity. In summary, GERD and FGIDs are associated with impaired autonomic dysfunction, mainly due to suppressed vagal and overactive sympathetic tone, which can be assessed noninvasively using HRV.
Collapse
|
4
|
Stress-induced hyperalgesia instead of analgesia in patients with chronic musculoskeletal pain. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2022; 13:100110. [PMID: 36561877 PMCID: PMC9764253 DOI: 10.1016/j.ynpai.2022.100110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
Many individuals with chronic musculoskeletal pain (CMP) show impairments in their pain-modulatory capacity. Although stress plays an important role in chronic pain, it is not known if stress-induced analgesia (SIA) is affected in patients with CMP. We investigated SIA in 22 patients with CMP and 18 pain-free participants. Pain thresholds, pain tolerance and suprathreshold pain ratings were examined before and after a cognitive stressor that typically induces pain reduction (SIA). Whereas the controls displayed a significant increase in pain threshold in response to the stressor, the patients with CMP showed no analgesia. In addition, increased pain intensity ratings after the stressor indicated hyperalgesia (SIH) in the patients with CMP compared to controls. An exploratory analysis showed no significant association of SIA or SIH with spatial pain extent. We did not observe significant changes in pain tolerance or pain unpleasantness ratings after the stressor in patients with CMP or controls. Our data suggest that altered stress-induced pain modulation is an important mechanism involved in CMP. Future studies need to clarify the psychobiological mechanisms of these stress-induced alterations in pain processing and determine the role of contributing factors such as early childhood trauma, catastrophizing, comorbidity with mental disorders and genetic predisposition.
Collapse
|
5
|
Rowlison de Ortiz A, Belda B, Hash J, Enomoto M, Robertson J, Lascelles BDX. Initial exploration of the discriminatory ability of the PetPace collar to detect differences in activity and physiological variables between healthy and osteoarthritic dogs. FRONTIERS IN PAIN RESEARCH 2022; 3:949877. [PMID: 36147035 PMCID: PMC9485802 DOI: 10.3389/fpain.2022.949877] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Accelerometry has been used to evaluate activity in dogs with osteoarthritis (OA) pain, especially in relation to effect of treatment; however no studies have compared accelerometry-measured activity in dogs with OA-pain and healthy dogs. The aims of this study were to (1) compare activity output from the PetPace collar with the validated Actical monitor and (2) determine if PetPace collar outputs (overall activity, activity levels, body position, and vital signs) differed between healthy dogs and dogs with OA-pain. Methods This was an observational, non-interventional study in healthy dogs and dogs with OA-pain. All dogs were outfitted with the PetPace collar and the Actical monitor simultaneously for 14 days. Output from these devices was compared (correlations), and output from the PetPace device was used to explore differences between groups across the activity and vital sign outputs (including calculated heart rate variability indices). Results There was moderate correlation between the PetPace collar and Actical monitor output (R2 = 0.56, p < 0.001). Using data generated by the PetPace collar, OA-pain dogs had lower overall activity counts and spent less time standing than healthy dogs. Healthy dogs spent more time at higher activity levels than OA-pain dogs. Certain heart rate variability indices in OA-pain dogs were lower than in healthy dogs. Conclusions and clinical relevance The results of this study suggest that the PetPace collar can detect differences between healthy dogs and those with OA-pain, and that OA-pain negatively impacts overall activity levels in dogs, and especially higher intensity activity.
Collapse
Affiliation(s)
- Avery Rowlison de Ortiz
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Office of Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Beatriz Belda
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Jon Hash
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Masataka Enomoto
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - James Robertson
- Office of Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - B. Duncan X. Lascelles
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Comparative Pain Research and Education Center, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Thurston Arthritis Center, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, United States
- Department of Anesthesiology, Center for Translational Pain Research, Duke University, Durham, NC, United States
- *Correspondence: B. Duncan X. Lascelles
| |
Collapse
|
6
|
Koyama Y, Fujiwara T, Doi S, Isumi A, Morita A, Matsuyama Y, Tani Y, Nawa N, Mashiko H, Yagi J. Heart rate variability in 2014 predicted delayed onset of internalizing problems in 2015 among children affected by the 2011 Great East Japan Earthquake. J Psychiatr Res 2022; 151:642-648. [PMID: 35661521 DOI: 10.1016/j.jpsychires.2022.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
Experience of natural disaster was related to an increased risk of long-term child internalizing problems. Initial traumatic experiences are hypothesized to work as disaster-related stresses and sensitize neural circuitry, leading to heightened reactivity to subsequent stressful experiences, which in turn results in delayed onset of internalizing problems. However, empirical evidence is lacking. Thus, we aimed to examine the association between heart rate variability (HRV) and internalizing problems among children exposed to the disaster. The Great East Japan Earthquake Follow-up for Children (GEJE-FC) study followed children aged 4-6 years old and their siblings and parents from three affected prefectures (Miyagi, Fukushima, and Iwate) and one unaffected prefecture (Mie) in Japan over four periods: from August 2012 to June 2013 (= T1), August 2013 to April 2014 (= T2), July 2014 to December 2014 (= T3), and August 2015 to December 2015 (= T4) (n = 155). HRV was assessed at T2 and T3 as a biomarker of autonomic nervous system activity. Child internalizing problems were assessed by caregivers at T3 and T4, using the Child Behavior Checklist. HRV measurements at T2 were not associated with child internalizing problems at T3. However, HRV in low frequency domains at T3 showed an inverse association with child internalizing problems at T4 (B = -1.72, 95% CI = -3.12 to -0.31). The findings indicated that later exacerbation of internalizing problems could be predicted by dysfunction of autonomic nervous system measured by HRV.
Collapse
Affiliation(s)
- Yuna Koyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan; Japan Society of the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Ayako Morita
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yusuke Matsuyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan; Department of Medical Education Research and Development, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hirobumi Mashiko
- Fukushima Rehabilitation Center for Children, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Junko Yagi
- Department of Neuropsychiatry, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-0023, Japan
| | | |
Collapse
|
7
|
Emotional Self-Regulation in Primary Education: A Heart Rate-Variability Biofeedback Intervention Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095475. [PMID: 35564869 PMCID: PMC9099602 DOI: 10.3390/ijerph19095475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
This study investigated the benefits of using a biofeedback intervention programme to train children in controlling their heart rate variability (HRV) through slow-paced breathing in real time. HRV biofeedback interventions focused on showing subjects to breathe such that their HRV numbers rise, improving their self-regulation. The HRV biofeedback intervention, focused on breathing, was conducted with primary education students aged between 7 and 11 years. The programme consisted of five biofeedback sessions, where students were taught to breathe six long and slow pairs of breaths per minute, to increase their HRV. After participation in the programme, students, regardless of gender, increased their HRV in a statistically significant fashion with a large effect, but this effect was not the same for all ages. HRV biofeedback interventions are rarely applied in schools and given the effectiveness of the intervention to improve HRV in children, the applied implications of our results in educational settings are discussed, especially taking into account the children’s ages.
Collapse
|
8
|
Emotional stress responsivity of patients with IBS - a systematic review. J Psychosom Res 2022; 153:110694. [PMID: 34942583 DOI: 10.1016/j.jpsychores.2021.110694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Irritable bowel syndrome (IBS) is a highly prevalent disorder of the gut-brain interaction characterized by abdominal discomfort and pain associated with altered bowel habits in the absence of structural abnormalities. Chronic psychological stress is considered a risk factor for the development of IBS. The multifactorial pathogenesis involves complex interactions between biological, psychological and social factors, yet the underlying mechanisms have not been fully understood. METHODS We systematically reviewed the literature from the databases MEDLINE, Embase and PsycINFO to assess stress responsivity of patients with IBS in comparison to healthy individuals, specifically focusing acute psychological stressors. RESULTS A total of 37 case-control studies were included in the narrative synthesis. Findings comprised subjective changes in emotion (k = 18) and of gastrointestinal symptoms (k = 8) as well as objective parameters of gastrointestinal motility (k = 10), autonomic nervous system (k = 23), hypothalamic-pituitary-adrenal axis (k = 11), functional brain activity (k = 7) and immune system (k = 3). Mental stress was found to increase IBS-specific symptomatology and alter gastrointestinal motility. Some patients with IBS showed stress-induced emotional hyperresponsivity and different patterns of neural activation. Autonomic and endocrine stress responses depend on the type of stressor and showed no clear evidence of differential reactivity, partly due to confounding factors. Data on acute immunological changes remains sparse and requires further investigation. CONCLUSIONS Current evidence suggests altered stress reactivity in patients with IBS however, it remains unclear whether it can be attributed to the syndrome itself or the high prevalence of psychiatric comorbidities.
Collapse
|
9
|
Caillet AR, Russell AC, Wild MG, Acra S, Bradshaw LA, Bruehl S, Walker LS, Stone AL. Sex Moderates the Relationship Between Nausea Severity and Heart Rate Variability in Adolescents and Young Adults. Dig Dis Sci 2022; 67:606-612. [PMID: 33608817 PMCID: PMC8373993 DOI: 10.1007/s10620-021-06892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nausea is a common complaint among children and is particularly prevalent in children with functional abdominal pain (FAP), with nearly half of children with FAP also endorsing nausea. Dysfunction of the autonomic nervous system, which can be indexed by heart rate variability (HRV), leads to abnormalities in gastric electrical activity that are associated with GI symptoms. AIMS To evaluate that relationship between nausea severity and HRV in adolescents and young adults with a history of FAP and to assess for sex differences. METHODS Participants were pediatric patients with a diagnosis of FAP who were recruited from a pediatric GI clinic between 1993 and 2007 for a prospective study of the course of FAP. Study analyses focused on the cross-sectional relationship between HRV, indexed by standard deviation of the R-R interval (SDRRI) and high-frequency (HF) power, and nausea severity collected during a follow-up visit in late adolescence and young adulthood. RESULTS Controlling for age and BMI, a significant nausea by sex interaction emerged for both SDRRI and HF power. Tests of conditional effects of nausea by sex showed that the inverse relation between nausea severity and both SDRRI and HF was significant for females but not for males. CONCLUSIONS This is the first study to evaluate the relationship between nausea severity and HRV. Greater nausea severity was associated with lower HRV in females but not in males. Further validation of these results may provide insight into novel treatment approaches for females with nausea that target vagal tone.
Collapse
Affiliation(s)
- Aimée R. Caillet
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Alexandra C. Russell
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Marcus G. Wild
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN
| | - Sari Acra
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Lynn S. Walker
- Division of Adolescent Medicine and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda L. Stone
- Division of Adolescent Medicine and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
10
|
Mekhail N, Costandi S, Saweris Y, Armanyous S, Chauhan G. Impact of biological sex on the outcomes of spinal cord stimulation in patients with chronic pain. Pain Pract 2021; 22:432-439. [PMID: 34845813 DOI: 10.1111/papr.13097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/19/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spinal cord stimulation (SCS) continues to gain increasing popularity in the pain management field for the treatment of different painful conditions; however, to-date, the correlation between the SCS effectiveness and biological sex has not been fully established. We aimed to investigate the correlation between the biological sex and SCS outcomes. METHODS Following Institutional Review Board approval, a retrospective cohort study was performed by collecting data for patients treated with SCS at a tertiary academic center between the years 2002 and 2019. Data was assessed with multivariable linear regression to investigate the association between biological sex and pain scores at baseline, 6-, and 12- months following SCS implantation. Propensity score matching (PSM) was performed based on a set of covariates including age, duration of pain, time since implant, BMI, opioid medications use, smoking, depression and history of alcohol, or substance abuse. RESULTS Of the patients treated with SCS implants, 418 patients fit the inclusion and exclusion criteria, out of which the majority were females (272, 65%). The pre-matching data reported a significant difference in history of diabetes and depression and was also significant for greater opioid use in male patients at baseline, 6-, and 12-months post-SCS implant. Propensity score matching (PSM) was performed based on the above mentioned covariant. After matching, no statistical difference was found among the variables, in both groups. Furthermore, after matching no significant differences in the pain scores at baseline, 6-, and 12-months post-SCS implant were observed. CONCLUSION No biological sex-based differences in the analgesic response to SCS therapy was detected at 6- and 12-months post-SCS implant between groups with similar demographics, biomedical, and psychological values.
Collapse
Affiliation(s)
- Nagy Mekhail
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shrif Costandi
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Youssef Saweris
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sherif Armanyous
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gaurav Chauhan
- University of Pittsburgh Medical Center (UPMC) Pain Medicine Program, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
11
|
de França Moreira M, Gamboa OL, Pinho Oliveira MA. Association between severity of pain, perceived stress and vagally-mediated heart rate variability in women with endometriosis. Women Health 2021; 61:937-946. [PMID: 34719338 DOI: 10.1080/03630242.2021.1993423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Olga Lucia Gamboa
- EQness, Sydney, New South Wales, Australia.,School of Psychology, University of Sydney, Camperdown, New South Wales, Australia
| | | |
Collapse
|
12
|
Posada-Quintero HF, Kong Y, Chon KH. Objective pain stimulation intensity and pain sensation assessment using machine learning classification and regression based on electrodermal activity. Am J Physiol Regul Integr Comp Physiol 2021; 321:R186-R196. [PMID: 34133246 DOI: 10.1152/ajpregu.00094.2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An objective measure of pain remains an unmet need of people with chronic pain, estimated to be 1/3 of the adult population in the United States. The current gold standard to quantify pain is highly subjective, based upon self-reporting with numerical or visual analog scale (VAS). This subjectivity complicates pain management and exacerbates the epidemic of opioid abuse. We have tested classification and regression machine learning models to objectively estimate pain sensation in healthy subjects using electrodermal activity (EDA). Twenty-three volunteers underwent pain stimulation using thermal grills. Three different "pain stimulation intensities" were induced for each subject, who reported the "pain sensation" right after each stimulus using a VAS (0-10). EDA data were collected throughout the experiment. For machine learning, we computed validated features of EDA based on time-domain decomposition, spectral analysis, and differential features. Models for estimation of pain stimulation intensity and pain sensation achieved maximum macroaveraged geometric mean scores of 69.7% and 69.2%, respectively, when three classes were considered ("No," "Low," and "High"). Regression of levels of stimulation intensity and pain sensation achieved R2 values of 0.357 and 0.47, respectively. Overall, the high variance and inconsistency of VAS scores led to lower performance of pain sensation classification, but regression was better for pain sensation than stimulation intensity. Our results provide that three levels of pain can be quantified with good accuracy and physiological evidence that sympathetic responses recorded by EDA are more correlated to the applied stimuli's intensity than to the pain sensation reported by the subject.
Collapse
Affiliation(s)
| | - Youngsun Kong
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| |
Collapse
|
13
|
Shibao CA, Joos K, Phillips JA, Cogan J, Newman JH, Hamid R, Meiler J, Capra J, Sheehan J, Vetrini F, Yang Y, Black B, Diedrich A, Roberston D, Biaggioni I. Familial Autonomic Ganglionopathy Caused by Rare CHRNA3 Genetic Variants. Neurology 2021; 97:e145-e155. [PMID: 33947782 PMCID: PMC8279568 DOI: 10.1212/wnl.0000000000012143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/08/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the molecular basis of a new monogenetic recessive disorder that results in familial autonomic ganglionopathy with diffuse autonomic failure. METHODS Two adult siblings from one family (I-4 and I-5) and another participant from a second family (II-3) presented with severe neurogenic orthostatic hypotension (nOH), small nonreactive pupils, and constipation. All 3 affected members had low norepinephrine levels and diffuse panautonomic failure. RESULTS Whole exome sequencing of DNA from I-4 and I-5 showed compound heterozygosity for c.907_908delCT (p.L303Dfs*115)/c.688 G>A (p.D230N) pathologic variants in the acetylcholine receptor, neuronal nicotinic, α3 subunit gene (CHRNA3). II-3 from the second family was homozygous for the same frameshift (fs) variant (p.L303Dfs*115//p.L303Dfs*115). CHRNA3 encodes a critical subunit of the nicotinic acetylcholine receptors (nAChRs) responsible for fast synaptic transmission in the autonomic ganglia. The fs variant is clearly pathogenic and the p.D230N variant is predicted to be damaging (SIFT)/probably damaging (PolyPhen2). The p.D230N variant lies on the interface between CHRNA3 and other nAChR subunits based on structural modeling and is predicted to destabilize the nAChR pentameric complex. CONCLUSIONS We report a novel genetic disease that affected 3 individuals from 2 unrelated families who presented with severe nOH, miosis, and constipation. These patients had rare pathologic variants in the CHRNA3 gene that cosegregate with and are predicted to be the likely cause of their diffuse panautonomic failure.
Collapse
Affiliation(s)
- Cyndya A Shibao
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX.
| | - Karen Joos
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - John A Phillips
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Joy Cogan
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - John H Newman
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Rizwan Hamid
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Jens Meiler
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - John Capra
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Jonathan Sheehan
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Francesco Vetrini
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Yaping Yang
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Bonnie Black
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - André Diedrich
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - David Roberston
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| | - Italo Biaggioni
- From the Department of Medicine (C.S., J.H.N., B.B., A.D., D.R., I.B.), Department of Ophthalmology and Visual Sciences, Biomedical Engineering (K.J.), Department of Pediatrics (J.A.P., J.C., R.H.), and Department of Biochemistry (J.M., J.C.), Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine (J.S.), Washington University in St. Louis, MO; Department of Medical and Molecular Genetics (F.V.), Indiana University School of Medicine, Indianapolis, IN; and Baylor Genetics and Baylor College of Medicine (Y.Y.), Baylor College of Medicine, Houston, TX
| |
Collapse
|
14
|
Koyama Y, Nawa N, Yamaoka Y, Nishimura H, Sonoda S, Kuramochi J, Miyazaki Y, Fujiwara T. Interplay between social isolation and loneliness and chronic systemic inflammation during the COVID-19 pandemic in Japan: Results from U-CORONA study. Brain Behav Immun 2021; 94:51-59. [PMID: 33705870 PMCID: PMC7939973 DOI: 10.1016/j.bbi.2021.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 01/16/2023] Open
Abstract
In the face of the global coronavirus disease 2019 (COVID-19) pandemic, billions of people were forced to stay at home due to the implementation of social distancing and lockdown policies. As a result, individuals lost their social relationships, leading to social isolation and loneliness. Both social isolation and loneliness are major risk factors for poor physical and mental health status through enhanced chronic inflammation; however, there might be an interplay between social isolation and loneliness on the association with chronic inflammation. We aimed to clarify the link between social relationships and inflammation in the context of the COVID-19 pandemic by distinguishing whether social isolation only, loneliness only, or both were associated with chronic inflammation markers among community-dwelling adults. The data of 624 people (aged 18-92 years, mean 51.4) from the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, which targeted randomly sampled households in Utsunomiya city, Japan, were analyzed. Social isolation was assessed as a structural social network by asking the number of social roles they have on a daily basis. Loneliness was measured with the UCLA loneliness scale. As chronic inflammation biomarkers, neutrophil-to-lymphocyte ratio (NLR) and the concentration of high-sensitivity C-reactive protein (CRP) were measured. Generalized estimating equations method was employed to take into account the correlations within households. Isolated-Lonely condition (i.e., being both socially isolated and feeling lonely) was associated with higher NLR among men (B = 0.141, 95%CI = -0.01 to 0.29). Interestingly, Nonisolated-Lonely condition (i.e., not socially isolated but feeling lonely) was associated with lower CRP among women (B = -0.462, 95%CI = -0.82 to -0.10) and among the working-age population (B = -0.495, 95%CI = -0.76 to -0.23). In conclusion, being both socially isolated and feeling lonely was associated with chronic inflammation. Assessing both social isolation and loneliness is critical for proper interventions to mitigate the impact of poor social relationships on health, especially in the context of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Yuna Koyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Nobutoshi Nawa
- Department of Medical Education Research and Development, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hisaaki Nishimura
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shiro Sonoda
- Kuramochi Clinic Interpark, Utsunomiya, Tochigi, Japan
| | - Jin Kuramochi
- Kuramochi Clinic Interpark, Utsunomiya, Tochigi, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| |
Collapse
|
15
|
Brown D, Schenk S, Genent D, Zernikow B, Wager J. A scoping review of chronic pain in emerging adults. Pain Rep 2021; 6:e920. [PMID: 34712883 PMCID: PMC8546842 DOI: 10.1097/pr9.0000000000000920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
Much of the adult chronic pain literature addresses pain in typical pain cohorts of middle-aged to older individuals. To date, little research has focused on chronic pain in younger adults, who likely have a completely different pain experience. This scoping review aimed to address this gap by describing the emerging adult (18-29 years) chronic pain experience regarding prevalence, associated factors, outcomes, and pain management. Searches of primary electronic databases including PubMed, Embase, PsycINFO, and CINAHL were performed on February 26, 2020, restricting the publication date from database inception to December 31, 2019. The search strategy, conducted in English, covered search term combinations of "chronic pain" and "young adults." A total of 6,612 records were considered-3,141 after removing duplicates. These records were screened by title and abstract; 871 through full-text screening. Of these, 78 articles covered the topic of emerging adults with chronic pain. Collectively, results indicated that between 5% and 30% of emerging adults experience chronic pain, depending on the sample and exact chronic pain definition. The most consistent associated factors were female sex, familial chronic pain, and previous experiences of chronic pain in childhood. Anxiety, depression, and sleep issues appeared associated both before and after the onset of chronic pain. Outcomes of pain included interruptions to study and work, poorer physical functioning, and pain-related interference to socializing. We observed that few pain treatments have been tested specifically in this cohort. A greater ongoing focus on chronic pain in emerging adults is required to improve long-lasting outcomes.
Collapse
Affiliation(s)
- Donnamay Brown
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Sabrina Schenk
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Dunja Genent
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| |
Collapse
|
16
|
Gibler RC, Jastrowski Mano KE. Systematic Review of Autonomic Nervous System Functioning in Pediatric Chronic Pain. Clin J Pain 2021; 37:281-294. [PMID: 33656000 DOI: 10.1097/ajp.0000000000000915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Chronic pain is a common and debilitating health problem that impacts up to one third of children and adolescents. The pathophysiological mechanisms of chronic pain are complex, but considerable research links dysfunction of the autonomic nervous system (ANS) and chronic pain in adults. No review of ANS functioning has been conducted in pediatric chronic pain. We systematically reviewed studies examining ANS activity among youth with primary chronic pain conditions. METHODS A systematic search of PsycINFO, PubMed, and CINAHL was conducted using specific search terms. Articles were included if studies measured heart rate, blood pressure, heart rate variability, galvanic skin responses, or pupillometry among children or adolescents with a chronic pain condition. Studies examining these factors in the context of a specific disease-related pain condition were excluded. RESULTS Of the 1304 articles screened, 15 studies met the criteria for inclusion in this review. All included studies were cross-sectional and primarily included youth with abdominal pain. Results revealed preliminary evidence of reduced parasympathetic activity among youth with pain as measured by heart rate variability. However, results were mixed across ANS indices. Measurement and procedural differences, in addition to a lack of control groups in some studies, limit the interpretability of the reviewed findings. DISCUSSION Additional studies with larger and more diverse samples of youth with various chronic primary pain conditions are needed to delineate possible relationships among ANS functioning and the development and maintenance of chronic pain in children and adolescents. Clinical implications and avenues for future research are discussed.
Collapse
Affiliation(s)
- Robert C Gibler
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | | |
Collapse
|
17
|
Hechler T. Altered interoception and its role for the co-occurrence of chronic primary pain and mental health problems in children. Pain 2021; 162:665-671. [PMID: 33021565 DOI: 10.1097/j.pain.0000000000002099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 09/23/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Tanja Hechler
- Department of Clinical Psychology and Psychotherapy in Children and Adolescents, University of Trier, Trier, Germany
| |
Collapse
|
18
|
Hu X, Dong S, Zhang B, Wang X, Yin Y, Liu C, Yu J, Wu X, Xu F, Meng C. Efficacy of silver needle therapy for the treatment of chronic nonspecific low back pain: a prospective, single-center, randomized, parallel-controlled clinical trial. Trials 2021; 22:75. [PMID: 33478570 PMCID: PMC7818943 DOI: 10.1186/s13063-021-05040-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic nonspecific low back pain (CNSLBP) troubles approximately 30% of people worldwide. Silver needle therapy (SNT) is a treatment method to relieve soft tissue pain through heating. Therefore, this study aimed to observe the effects of SNT on CNSLBP. METHODS In this study, 100 patients were randomly divided into 2 groups: silver needle (SN) group and control group (n = 50). In the SN group, patients received SNT and physiotherapy, while patients received physiotherapy alone in the control group. At the 6-month follow-up, the numerical rating scale (NRS), Oswestry Disability Index (ODI), Short-Form 12 of quality of life (SF-12), the natural logarithms of low-frequency measurement (InLF), and the natural logarithms of high-frequency measurement (InHF) of heart rate variability (HRV) were recorded. RESULTS In both groups, NRS, ODI, SF-12 scores, and HRV at 2 weeks after treatment were improved and maintained for 6 months. Compared with the control group, more significant improvements were observed in the NRS and SF-12 scores at 1, 2, 3, and 6 months and in the ODI scores at 1 and 2 months in the SN group (P < 0.05). However, there was no significant difference between the groups in the ODI scores at 3 and 6 months. InLF and InHF in the SN group were higher than those in the control group at 3 and 6 months (P < 0.05). CONCLUSIONS SNT relieved pain and improved quality of life and autonomic nerve activity, especially parasympathetic nerve, in patients with CNSLBP, without serious complications. TRIAL REGISTRATION Chinese Clinical Trial Registry No. ChiCTR-OOC-17013237 . Registered on November 11, 2017.
Collapse
Affiliation(s)
- Xuesong Hu
- Department of Pain, the People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Shaoxing Dong
- Department of Pain, the People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Bing Zhang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuan Wang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanwei Yin
- Department of Pain Management, The Affiliated Hospital of Qingdao University, No. 1677, Wutai Mountain Road, Huangdao District, Qingdao City, 266000, Shan Dong Province, China
| | - Chuansheng Liu
- Department of Pain Management, The Affiliated Hospital of Qingdao University, No. 1677, Wutai Mountain Road, Huangdao District, Qingdao City, 266000, Shan Dong Province, China
| | - Junmin Yu
- Department of Pain Management, The Affiliated Hospital of Qingdao University, No. 1677, Wutai Mountain Road, Huangdao District, Qingdao City, 266000, Shan Dong Province, China
| | - Xing Wu
- Department of Pain Management, The Affiliated Hospital of Qingdao University, No. 1677, Wutai Mountain Road, Huangdao District, Qingdao City, 266000, Shan Dong Province, China
| | - Fenghu Xu
- Department of Pain Management, The Affiliated Hospital of Qingdao University, No. 1677, Wutai Mountain Road, Huangdao District, Qingdao City, 266000, Shan Dong Province, China
| | - Chao Meng
- Department of Pain Management, The Affiliated Hospital of Qingdao University, No. 1677, Wutai Mountain Road, Huangdao District, Qingdao City, 266000, Shan Dong Province, China.
| |
Collapse
|
19
|
Alterations in Heart Rate Variability Associated With Irritable Bowel Syndrome or Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2020; 12:e00275. [PMID: 33346998 PMCID: PMC7752679 DOI: 10.14309/ctg.0000000000000275] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are gastrointestinal pathologies affecting large numbers of the global population and incurring significant healthcare costs. Disruptions in the gut-brain axis occurring in these conditions can lead to increased inflammation, affecting gastrointestinal and autonomic nervous system function. Heart rate variability (HRV) is commonly used to assess the state of the sympathetic and parasympathetic function of the autonomic nervous system, but it remains unclear how HRV measures are associated with gastrointestinal pathologies. Here, we conduct a systematic review of the literature comparing HRV of subjects diagnosed with IBS or IBD to HRV in healthy controls (HC). METHODS: We searched PubMed, Cochrane Library, and CINAHL (EBSCO) for eligible studies up to 2018. We included any study comparing a recognized measure of HRV between a group of patients with either IBS or IBD to a group of matched HC before any intervention. Studies were screened, and data were extracted from included articles using predefined criteria. Random effects meta-analysis was performed for each outcome, with effect size reported as the standardized mean difference. RESULTS: There were significant differences between IBD and HC in time domain HRV and significant decreases in high-frequency power measures were also noted, in both IBS and IBD compared with HC. DISCUSSION: Parasympathetic nervous system activity, represented through high-frequency power, seems to be lower in people with IBS and IBD, but conclusions are limited by the small number of studies that provide usable data, methodological heterogeneity, and high risks of bias in primary study methods and measures.
Collapse
|
20
|
Vargas-Luna FM, Huerta-Franco MR, Schurman JV, Deacy AD, Bagherian A, Harvey L, Friesen CA. Electrogastrographic and autonomic nervous system responses to solid and liquid meals in youth with functional dyspepsia. Neurogastroenterol Motil 2020; 32:e13785. [PMID: 32017336 DOI: 10.1111/nmo.13785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/29/2019] [Accepted: 11/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Meal-related symptoms are common in paediatric functional dyspepsia (FD). There are only a small number of paediatric studies assessing mechanisms for meal-related symptoms, and these have not utilized Rome IV criteria. The aim of the current study was to assess gastric myoelectric and autonomic nervous system (ANS) responses to both liquid and solid meals in youth with Rome IV-defined FD. METHODS In healthy controls (N = 14) and youth with FD (N = 12), we recorded electrocardiograph (to assess heart rate variability; HRV) and electrogastrograph (EGG) signals before and after two test meals, one liquid and one solid. EGG parameters and HRV were assessed for the entire pre- and postprandial periods and in short time intervals. Additionally, liquid gastric emptying was assessed utilizing a 13 C-acetate breath test. KEY RESULTS During the EGG, the dominant power increased with both meals in controls but not patients with FD. During HRV assessment, the low frequency to high frequency ratio was higher after the liquid meal in controls, despite being similar preprandial, as compared to patients with FD. In controls, both standard deviation of normal to normal waves (SDNN) and root mean square of successive ECG R peaks (R-R interval) differences (rMSSD) increased after the liquid meal (but not after the solid meal) in controls but not patients with FD. CONCLUSIONS AND INFERENCES Youth with Rome IV-defined FD lacks the normal postprandial EGG dominant power response or autonomic nervous system response following a liquid meal. The latter appears to indicate a lack of ANS flexibility.
Collapse
Affiliation(s)
- Francisco Miguel Vargas-Luna
- Division of Sciences and Engineering, Department of Physical Engineering, Universidad de Guanajuato, Leon Gto, Mexico
| | - María Raquel Huerta-Franco
- Division of Health Sciences, Department of Applied Science to Work, Universidad de Guanajuato, Leon Gto, Mexico
| | - Jennifer V Schurman
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Amanda D Deacy
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Amber Bagherian
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Lisa Harvey
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Craig A Friesen
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| |
Collapse
|
21
|
Heart Rate Variability and Gastric Electrical Response to a Cold Pressor Task in Youth with Functional Dyspepsia. Dig Dis Sci 2020; 65:1074-1081. [PMID: 31549333 DOI: 10.1007/s10620-019-05848-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS While stress has been implicated in functional dyspepsia (FD), the mechanisms by which stress results in symptoms are not well defined. The aim of the current study was to assess gastric myoelectric and autonomic changes in response to a physical stressor in youth with FD. METHODS In a group of healthy controls and pediatric FD subjects, we recorded ECG and EGG signals 30 min before and 60 min after, a cold pressor task (CPT). Gastric EGG and heart rate variability (HRV) parameters were calculated in pre- and post-CPT stages and in short intervals. RESULTS The pre-CPT percent tachygastria was higher in FD subjects as compared to controls. However, CPT did not induce any EGG changes in either controls or FD subjects and the two groups did not differ from each other post-CPT. The CPT resulted in an increase in HRV and standard deviation of NN intervals in controls; there was no change in any HRV parameter in FD subjects. CONCLUSIONS Acute physical stress does not appear to induce gastric electrical abnormalities in youth with FD. Youth with FD appear to lack the normal flexible autonomic response to a physical stressor.
Collapse
|
22
|
Naranjo-Hernández D, Reina-Tosina J, Roa LM. Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E365. [PMID: 31936420 PMCID: PMC7014460 DOI: 10.3390/s20020365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/15/2022]
Abstract
Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.
Collapse
Affiliation(s)
- David Naranjo-Hernández
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
| | | | | |
Collapse
|
23
|
McInnis PM, Braund TA, Chua ZK, Kozlowska K. Stress-system activation in children with chronic pain: A focus for clinical intervention. Clin Child Psychol Psychiatry 2020; 25:78-97. [PMID: 31364391 DOI: 10.1177/1359104519864994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Accumulating evidence indicates that psychological and neurophysiological processes interconnect and interact to activate the body's stress system and to trigger and maintain functional somatic symptoms. This study used the Early Life Stress Questionnaire, Depression Anxiety Stress Scales and biological markers (heart rate, heart rate variability, skin conductance, C-reactive protein (CRP) titre, respiratory rate, and accuracy and reaction time in an emotion-face identification task), to examine childhood adversity, psychological distress and stress-system activation in 35 children and adolescents (23 girls and 12 boys, 9-17 years old) disabled by chronic pain (vs two groups of age- and sex-matched healthy controls). Patients reported more early-life stress (U = 798.5, p = .026) and more psychological distress (U = 978, p < .001). They showed activation of the autonomic system: elevated heart rate (U = 862.5, p = .003), elevated electrodermal activity (U = 804.5, p = .024) and lower heart rate variability in the time domain (U = 380.5, p = .007) and frequency domain (U = 409.5, p = .017). The group showed an upward shift of CRP titres (with 75th and 90th CRP percentiles of 4.5 and 10.5 mg/L, respectively), suggesting the activation of the immune-inflammatory system. Elevated CRP titres were associated with elevated heart rate (p = .028). There were no differences in respiratory rate or in accuracy and reaction time in the emotion-face identification task. The results indicate that interventions for children and adolescents with chronic pain need a multidisciplinary mind-body approach that concurrently addresses psychological distress, physical impairment and stress-system dysregulation.
Collapse
Affiliation(s)
- Peter M McInnis
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia
| | - Taylor A Braund
- Total Brain, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Zhi Kai Chua
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, Australia.,Sydney Medical School, University of Sydney, Australia
| |
Collapse
|
24
|
Are 15-Year Trajectories of Low Back Pain and Sciatica Associated With Cardiovascular Autonomic Function in the General Population?: The Northern Finland Birth Cohort 1966 Study. Spine (Phila Pa 1976) 2019; 44:E1325-E1335. [PMID: 31232978 DOI: 10.1097/brs.0000000000003126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A population-based cohort study. OBJECTIVE The aim of this study was to examine whether 15-year trajectories of low back pain (LBP) and sciatica are associated with cardiovascular autonomic function in a large general population sample. SUMMARY OF BACKGROUND DATA Previous studies using mainly small patient samples have suggested that LBP and sciatica are associated with abnormal cardiovascular autonomic function, namely altered heart rate variability (HRV) and baroreflex sensitivity (BRS). We examined this association in a large general population sample. METHODS The data collections of the Northern Finland Birth Cohort 1966 consisted of pain questionnaires at 31 and 46 years (history of LBP, sciatica, and other musculoskeletal pains during the previous year; yes/no for each) and measurements of HRV and BRS at 46 years (heart rate, HR; root mean square of successive differences in beat-to-beat intervals, rMSSD; low-frequency systolic blood pressure variability, SBPV; cross-spectral BRS, BRS; each while seated and standing). The data collections also comprised several confounders. Trajectories for LBP, sciatica, and both together ("no pain," "decreasing," "increasing," "long-term pain") were constructed and general linear models were used to perform comparisons between trajectories (for HR/rMSSD, n = 3398; for SBPV/BRS, n = 1667). RESULTS In the crude models, LBP and sciatica were associated with higher HR, lower rMSSD, higher SBPV, and lower BRS, but these associations were mostly attenuated by adjustments. Regarding both LBP and sciatica, only the "increasing" trajectory was associated with two of the eight outcomes (standing SBPV, seated BRS) after adjustments. Regarding LBP, the "increasing" trajectory was associated with three (standing SBPV, seated BRS, standing BRS), the "long-term pain" trajectory with one (standing BRS), and the "decreasing" trajectory with one outcome (seated SBPV) after adjustments. Sciatica showed no association with the outcomes after adjustments. CONCLUSION We conclude that the 15-year trajectories of LBP and sciatica do not have a consistent independent association with cardiovascular autonomic function among the general population. LEVEL OF EVIDENCE 3.
Collapse
|
25
|
Walker LS. Commentary: Understanding Somatic Symptoms: From Dualism to Systems, Diagnosis to Dimensions, Clinical Judgement to Clinical Science. J Pediatr Psychol 2019; 44:862-867. [PMID: 31241136 DOI: 10.1093/jpepsy/jsz050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/24/2019] [Accepted: 05/15/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lynn S Walker
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center
| |
Collapse
|
26
|
Bruehl S, Olsen RB, Tronstad C, Sevre K, Burns JW, Schirmer H, Nielsen CS, Stubhaug A, Rosseland LA. Chronic pain-related changes in cardiovascular regulation and impact on comorbid hypertension in a general population: the Tromsø study. Pain 2019; 159:119-127. [PMID: 28953193 DOI: 10.1097/j.pain.0000000000001070] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Heart rate variability (HRV) and baroreflex sensitivity (BRS) are indexes reflecting the ability to maintain cardiovascular homeostasis amidst changing conditions. Evidence primarily from small studies suggests that both HRV and BRS may be reduced in individuals with chronic pain (CP), with potential implications for cardiovascular risk. We compared HRV and BRS between individuals with CP (broadly defined) and pain-free controls in a large unselected population sample. Participants were 1143 individuals reporting clinically meaningful CP and 5640 pain-free controls who completed a 106-second cold pressor test (CPT). Participants self-reported hypertension status. Resting HRV and BRS were derived from continuous beat-to-beat blood pressure recordings obtained before and after the CPT. Hierarchical regressions for the pre-CPT period indicated that beyond effects of age, sex, and body mass index, the CP group displayed significantly lower HRV in both the time domain (SDNN and rMSSD) and frequency domain (high-frequency HRV power), as well as lower BRS. Results were somewhat weaker for the post-CPT period. Mediation analyses indicated that for 6 of 7 HRV and BRS measures tested, there were significant indirect (mediated) effects of CP status on the presence of comorbid hypertension via reduced HRV or BRS. Results confirm in the largest and broadest sample tested to date that the presence of CP is linked to impaired cardiovascular regulation and for the first time provide support for the hypothesis that links between CP and comorbid hypertension reported in previous population studies may be due in part to CP-related decrements in cardiovascular regulation.
Collapse
Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Knut Sevre
- Cardiology, Oslo University Hospital, Oslo, Norway
| | - John W Burns
- Department of Behavioral Science, Rush University, Chicago, IL, USA
| | - Henrik Schirmer
- Division of Medicine and Laboratory Sciences, Akershus University Hospital, Lørenskog, Norway.,Department of Clinical Medicine, University of Tromsø, The Arctic University, Tromsø, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christopher Sivert Nielsen
- Department of Aging, Norwegian Institute of Public Health, Oslo, Norway.,Departments of Pain Management and Research and
| | - Audun Stubhaug
- Departments of Pain Management and Research and.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
27
|
Oura P, Hautala A, Kiviniemi A, Auvinen J, Puukka K, Tulppo M, Huikuri H, Seppänen T, Karppinen J. Musculoskeletal pains and cardiovascular autonomic function in the general Northern Finnish population. BMC Musculoskelet Disord 2019; 20:45. [PMID: 30704437 PMCID: PMC6357438 DOI: 10.1186/s12891-019-2426-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/18/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Heart rate variability (HRV) and baroreflex sensitivity (BRS) measurements provide means for the objective assessment of cardiovascular autonomic function. As previous studies have associated chronic pain with abnormal autonomic function, we aimed to characterize the relationship between the number of musculoskeletal pain sites (NPS), pain intensity, and cardiovascular autonomic function among the population-based Northern Finland Birth Cohort 1966. METHODS At the age of 46, cohort members self-reported their musculoskeletal pains (enabling the determination of NPS [0-8] and pain intensity [Numerical Rating Scale, NRS, 0-10]) and underwent clinical assessments of cardiovascular autonomic function in seated and standing positions (HRV variables: heart rate [HR] and root mean square of successive differences in beat-to-beat intervals [rMSSD] for the entire cohort; BRS variables: low-frequency systolic blood pressure variability [SBPV] and cross-spectral baroreflex sensitivity [BRS] for those attending the examination in Oulu, Finland). Extensive confounder data were also collected (body mass index, physical activity, smoking, Hopkins Symptom Checklist-25, comorbidities, and medications). The full samples included 4186 and 2031 individuals (HRV and BRS samples, respectively). Three subanalyses focused on individuals with intense and frequent pain, individuals with symptoms of depression and anxiety, and the relationship between pain intensity and autonomic parameters. RESULTS Linear regression models showed varying associations between NPS, pain intensity, and cardiovascular autonomic parameters. However, after all adjustments NPS was only associated with one outcome among women (BRS, standing: beta = - 0.015, p = 0.048) and two among men (HR, seated: beta = - 0.902, p = 0.003; HR, standing: beta = - 0.843, p = 0.014). Pain intensity was not associated with any outcome after full adjustments. Significant sex*pain interactions were found in the data. CONCLUSIONS Our data suggest that musculoskeletal pain has, at most, a limited independent association with cardiovascular autonomic function. Future studies should carefully account for the potential confounders and sex interactions that this study revealed.
Collapse
Affiliation(s)
- Petteri Oura
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland. .,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.
| | - Arto Hautala
- Faculty of Information Technology and Electrical Engineering, Center for Machine Vision and Signal Analysis, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
| | - Antti Kiviniemi
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.,Faculty of Medicine, Research Unit of Internal Medicine, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
| | - Juha Auvinen
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
| | - Katri Puukka
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.,NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
| | - Mikko Tulppo
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.,Faculty of Medicine, Research Unit of Internal Medicine, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
| | - Heikki Huikuri
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.,Faculty of Medicine, Research Unit of Internal Medicine, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
| | - Tapio Seppänen
- Faculty of Information Technology and Electrical Engineering, Center for Machine Vision and Signal Analysis, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
| | - Jaro Karppinen
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.,Finnish Institute of Occupational Health, Aapistie 1, FI-90220, Oulu, Finland
| |
Collapse
|
28
|
Allen TM, Struemph KL, Toledo-Tamula MA, Wolters PL, Baldwin A, Widemann B, Martin S. The Relationship Between Heart Rate Variability, Psychological Flexibility, and Pain in Neurofibromatosis Type 1. Pain Pract 2018; 18:969-978. [PMID: 29570943 PMCID: PMC6675567 DOI: 10.1111/papr.12695] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 12/01/2022]
Abstract
Individuals with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PNs) can experience chronic pain. Previous research has examined the relationship between heart rate variability (HRV) and persistent pain. HRV is an index of autonomic nervous system functioning, and reflects the variability in time elapsed between heartbeats. Patients with chronic pain tend to exhibit lower HRV, which has been associated with poor adaptability, or psychological flexibility, to stress. The aim of the current study was to examine relationships between HRV, psychological flexibility, and pain in a sample of adolescents and young adults (AYAs) with NF1 and PNs. AYA participants (n = 40) 16 to 34 years of age with NF1 completed baseline measures of pain and psychological functioning, and underwent a 5-minute electrocardiogram (ECG). A subset of 20 participants completed follow-up questionnaires and a second ECG 8 weeks later. Spectral analyses of ECGs yielded a measure of high-frequency heart rate variability (HF-HRV). Baseline correlations revealed that lower HF-HRV is related to greater inflexibility and more pain interference, but not pain intensity. Moreover, psychological inflexibility significantly mediated the relationship between HF-HRV and pain interference. Finally, regression models indicated that baseline psychological inflexibility is a significant predictor of HF-HRV at follow-up and, separately, that baseline HF-HRV significantly predicted pain intensity at follow-up. These findings suggest complex mind-body processes in the experience of pain in NF1, which have not been studied previously. Implications for pain-related interventions and future research are discussed.
Collapse
Affiliation(s)
- Taryn M. Allen
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland
| | - Kari L. Struemph
- Health Psychology and Neurobehavioral Research Group, National Cancer Institute, Bethesda, Maryland
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, U.S.A
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland
| | - Pamela L. Wolters
- Health Psychology and Neurobehavioral Research Group, National Cancer Institute, Bethesda, Maryland
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, U.S.A
| | - Andrea Baldwin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, U.S.A
| | - Brigitte Widemann
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, U.S.A
| | - Staci Martin
- Health Psychology and Neurobehavioral Research Group, National Cancer Institute, Bethesda, Maryland
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, U.S.A
| |
Collapse
|
29
|
Joo SY, Hong AR, Lee BC, Choi JH, Seo CH. Autonomic nerve activity indexed using 24-h heart rate variability in patients with burns. Burns 2018; 44:834-840. [PMID: 29409672 DOI: 10.1016/j.burns.2017.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is a noninvasive method used to quantify fluctuations in the time interval between normal heart beats. The purpose of this study was to compare the autonomic nervous system functioning of patients with burns to healthy participants after their burn scars had been re-epithelialized. MATERIALS AND METHODS The authors prospectively performed 24-h HRV monitoring in 60 patients with electrical burns, those with other major burns, those with other minor burns, and 10 healthy participants. Analysis of HRV in the time and frequency domain was performed. RESULTS The difference in sympathetic nerve measures (standard deviation of NN intervals [SDNN], total power [TP] and a low frequency [LF] band) and parasympathetic nerve measures (Root mean square successive difference [RMSSD], the number of interval differences of successive NN intervals greater than 50ms [NN50], the percentage of differences between following RR intervals greater than 50ms [pNN50] and a high frequency [HF] band) in patients with burns was significantly decreased during the daytime and the nighttime. the difference in parasympathetic nerve measures were more significantly decreased during the nighttime compared with measures of HRV in healthy participants. The groups of other burns showed significantly lower HRV than the electrical burn group indexed by a very low frequency (VLF) measure and TP during the daytime. CONCLUSION We hypothesized that HRV is a surrogate for autonomic nervous system dysfunction in patients with burns. The patients with burns were observed a sympathetic predominance during daytime and a decreased parasympathetic activity during nighttime. These results of patients with other major burns were more predominant compared with the results of patients with other groups.
Collapse
Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - A Ram Hong
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Boung Chul Lee
- Department of Neuropsychiatry, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Jae Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea.
| |
Collapse
|
30
|
|
31
|
Hoffmann A, Ettinger U, Reyes del Paso GA, Duschek S. Executive function and cardiac autonomic regulation in depressive disorders. Brain Cogn 2017; 118:108-117. [DOI: 10.1016/j.bandc.2017.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 11/28/2022]
|