Background & Aims
There is evidence that autonomic control measured by heart rate variability (HRV) and blood pressure variability (BPV) is related to the regulation of attention, processing of affective information and physiological flexibility. Additionally, spontaneous baroreflex sensitivity (SBS) is considered a robust and interpretable measure of balance (health) and the effectiveness of cardiovascular autonomic control. It is possible that HRV is an indication of flexible and adaptive regulation in the presence of aversive stimuli, such as pain1. Thus, when rapid vagal modulation of cardiac function is decreased, the organism is less able to track rapid changes in the environment and respond appropriately to the stimulus. Aim: Therefore, this study aimed to compare HRV, BPV and SBS at baseline between the chronic shoulder pain (CSP) and pain-free control (PFC) groups.
Methods
This cross-sectional study was approved by the Research Ethics Committee CAAE:67931623.6.0000.5414. The study included people with chronic shoulder pain and pain-free control being over 18 years old. Clinical diagnosis of cardiovascular diseases, continuous intake of medication, high levels of sports activities, and smoking habits were excluded. The participants remained in the supine position for 20 minutes and only the final 10 minutes were analyzed. They were instructed not to move or sleep during the study. HRV data were obtained using the RR intervals from the electrocardiographic record. BPV values were obtained from the beat-to-beat systolic blood pressure data with a cuff positioned on the middle finger of the right upper limb (Finometer Pro). The SBS was assessed in the time domain using the sequence technique. In the analysis of HRV and BPV, we used the low frequency. In the SBS we used the sequence method also presents the baroreflex effectiveness index.
Results
The sample was composed of 24 participants, 12 in the CSP group and 12 in the PFC group. The mean and standard deviation (Sd.) of the age of the CSP group was 43.2 (14.5) and in the PFC group was 27.4 (3.1). MANOVA showed that there is an effect of HRV, BPV, and SBS on the supine position among the groups with chronic shoulder pain and pain-free control group [Pillai’s Trace=0.45184; F(3, 21)=5.7699;p<0.001]. Subsequent univariate ANOVAs showed that there is an effect of SBS on different groups [F(1, 23)=11.316;p<0.001]. However, HRV [F(1, 23)=0.025;p=0.87] and BPV [F(1, 23)=0.134; p= 0.71] did not have an effect on different groups. Bonferroni’s post hoc test showed that there is a difference in SBS between groups, therefore there was no difference in HRV and BPV.
Conclusions
Participants with chronic shoulder pain exhibited autonomic modulation alterations, expressed by decreased values of baroreflex sensitivity, but not by differences in heart rate and blood pressure variability. Our study presents preliminary results. A robust sample is needed to conclude the findings in people with chronic shoulder pain.
References
1.Thayer JF, Åhs F, Fredrikson M, Sollers JJ, Wager TD. A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev. 2012;36(2):747-756. doi:10.1016/j.neubiorev.2011.11.009
2.Rossi DM, de Souza HCD, Bevilaqua-Grossi D, et al. Impairment on Cardiovascular Autonomic Modulation in Women with Migraine. Int J Environ Res Public Health. 2023;20(1). doi:10.3390/ijerph20010763
3.Bandeira PM, Reis FJJ, Muniz FDN, Chaves ACS, Fernandes O, Arruda-Sanchez T. Heart Rate Variability and Pain Sensitivity in Chronic Low Back Pain Patients Exposed to Passive Viewing of Photographs of Daily Activities. Clinical Journal of Pain. 2021;37(8):591-597. doi:10.1097/AJP.0000000000000953
4.Philbois S V., Facioli TP, Gastaldi AC, et al. Important differences between hypertensive middle-aged women and men in cardiovascular autonomic control—a critical appraisal. Biol Sex Differ. 2021;12(1). doi:10.1186/s13293-020-00355-y
Presenting Author
Marcela Camargo Tozzo
Poster Authors
Topics
- Models: Musculoskeletal