Background & Aims
Persistent shoulder pain may decrease your ability to perform daily activities. Pain is an aversive stimulus that triggers physiological responses controlled by the autonomic nervous system (ANS) and emotions are understood by changes in the ANS in response to a salient stimulus. Heart rate variability (HRV) can provide an available measure that reflects the perceptions of threat and safety in the environment. It is plausible to expect a physiological defensive response in patients with chronic shoulder pain (CSP) when they are exposed to a passive visualization task using images that may arouse fears of harm. Aim: To investigate emotional reactivity by measuring HRV and pressure pain threshold (PPT) before, during and after viewing shoulder movement images in people with CSP.
Methods
This cross-sectional study was approved by the Research Ethics Committee and registered under the number CAAE:67931623.6.0000.5414. The study included people with chronic shoulder pain 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 were submitted to a passive visualization task using 24 shoulder movements images. The presentation of the images started with a fixation point in the form of a white cross (+) on a black background for five seconds. Next, the image was displayed for six seconds on the full screen. HRV frequency domains were measured 5 minutes before, during, and after the task. HRV were obtained using the RR intervals from the electrocardiographic record. PPT were also measured before and after the task. The HRV (LF, HF and LF/HF) and PPT data was measured using paired sample t test.
Results
The sample comprised 12 participants, with a mean age of 43.2 and standard deviation (SD) of 14.5. The mean of HRV variance before and during task was 3152.6ms2(2339.2) and 2827.6ms2(1986.6), respectively. No differences were found in LF compared to the baseline and the task t(11)=1.046,p=0.318, and during and after the task t(11)=-0.83,p=0.572. Similar results were observed in HF during the baseline and the task t(11)=-1.046,p=0.318 and during and after the task t(11)=612,p=0.553. The difference of LF/HF was not significant during the baseline and the task t(11)=1.325,p=0.212. It was also not significant during and after the task t(11)=-1.085,p=0.301. Nevertheless, PPT decreased after the task in the low back pain group across all body sites: right deltoid t(11)=8.139,p<0.05), left deltoid t(11)=4.353,p<0.05, right anterior tibialis t(11)=9.749,p<0.05), and left anterior tibialis t(11)=12.004,p<0.05.
Conclusions
Although we found no difference in HRV before, during, and after the task, HRV exhibited a lower average (variance) during the viewing of the images. A relative reduction in vaguely mediated HRV is consistent with deficient symptoms of attentional control, emotional, and behavioral regulation2. Participants with CSP presented higher pain sensitivity when exposed to a passive visualization task using shoulder movement images. It is important to emphasize that these are preliminary results. A larger sample size and a comparison of results with individuals without pain are necessary.
References
1.Bradley MM, Codispoti M, Cuthbert BN, Lang PJ. Emotion and Motivation I: Defensive and Appetitive Reactions in Picture Processing. Emotion. 2001;1(3):276-298. doi:10.1037/1528-3542.1.3.276
2.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
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
5.Tozzo MC, Reis FJJ dos, Ansanello W, Meulders A, Vlaeyen J, Oliveira AS de. Impacto Motivacional Evocado Por Imagens de Movimento Do Ombro Em Participantes Com Dor No Ombro. Dissertação de Mestrado. Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP/USP); 2022.
6.Ansanello W, Reis FJJ Dos, Tozzo MC, et al. Development of the Avoidance Daily Activities Photo Scale for Patients with Shoulder Pain. Phys Ther. 2022;102(2):1-11. doi:10.1093/ptj/pzab268
Presenting Author
Marcela Camargo Tozzo
Poster Authors
Marcela Tozzo
MSc
Sao Paulo University
Lead Author
Felipe Reis
Federal Institute of Rio De Janeiro
Lead Author
Hugo Souza
PhD
Ribeirao Preto Medical School, University of Sao Paulo, Brazil
Lead Author
Ana Catarine Veiga
Ribeirao Preto Medical School, University of Sao Paulo, Brazil
Lead Author
Naiara Chinellato
Ribeirao Preto Medical School, University of Sao Paulo, Brazil
Lead Author
Anamaria Siriani de Oliveira
Universidade de São Paulo
Lead Author
Topics
- Models: Musculoskeletal