Background & Aims

The high prevalence of chronic pain has placed a colossal burden on global healthcare. The systemic manifestations of chronic pain, including autonomic dysregulation, are well documented. Heart rate variability (HRV), or the difference in the amount of time between each beat of the heart, has been used extensively as a measure of autonomic dysregulation. Previous literature has demonstrated a strong correlation between diminished HRV and chronic pain. However, while chronic pain is associated with reduced HRV, this phenomenon has not been investigated across the pain spectrum. The aim of this study was to explore the relationship between HRV and the presence and duration of pain by assessing the potential difference in HRV across three pain groups: those with chronic pain, those with acute pain and those without pain.

Methods

Subjects sat comfortably and completed a survey while wearing a Polar H10 heart rate sensor, which captured HRV through the Elite HRV application for at least 5 minutes. In addition to sociodemographic information, the survey asked participants to categorize their current pain. Chronic pain was defined as pain persisting for at least 3 months and acute pain was defined as less than 3 months. HRV variables of high-frequency (HFP) and low-frequency power (LFP), and LF/HF ratio were extracted from the Elite HRV app.

Results

One-way analysis of variance (ANOVA) was performed on seventy-eight participants. Mean scores for HFP, LFP, and LF/HF ratio were 645.23 ms2, 998.83 ms2, 3.09 (no pain), 471.16 ms2, 1122.75 ms2, 3.11(acute pain) and 581.30 ms2, 595.25 ms2, 2.55 (chronic pain), respectively. ANOVA revealed no statistically significant differences between pain groups for HFP, F(2,76) = .15, p = .861, LFP, F(2,76) = 2.91, p = .061, or LF/HF ratio F(2,76) = .349, p = .707.

Conclusions

While between-group differences for LFP neared significance, HRV was not statistically different in subjects that were experiencing pain than those not experiencing pain. This is in contrast to previous literature suggesting diminished HRV with chronic pain as compared to participants without pain. These results support pain as a complex experience, with numerous biopsychosocial factors influencing presentation.

References

1. Steglitz J, Buscemi J, Ferguson MJ. The future of pain research, education, and treatment: a summary of the IOM report “Relieving pain in America: a blueprint for transforming prevention, care, education, and research.” Transl Behav Med. 2012;2(1):6-8. doi:10.1007/s13142-012-0110-2
2. Gaskin DJ, Richard P. The Economic Costs of Pain in the United States. National Academies Press (US); 2011. Accessed November 10, 2020. https://www.ncbi.nlm.nih.gov/books/NBK92521/
3. Mostoufi SM, Afari N, Ahumada SM, Reis V, Wetherell JL. Health and distress predictors of heart rate variability in fibromyalgia and other forms of chronic pain. Journal of Psychosomatic Research. 2012;72(1):39-44. doi:10.1016/j.jpsychores.2011.05.007
4. 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. 2018;159(1):119-127. doi:10.1097/j.pain.0000000000001070
5. Tracy LM, Ioannou L, Baker KS, Gibson SJ, Georgiou-Karistianis N, Giummarra MJ. Meta-analytic evidence for decreased heart rate variability in chronic pain implicating parasympathetic nervous system dysregulation: PAIN. 2016;157(1):7-29. doi:10.1097/j.pain.0000000000000360
6. Koenig J, Williams DP, Kemp AH, Thayer JF. Vagally mediated heart rate variability in headache patients—a systematic review and meta-analysis. Cephalalgia. 2016;36(3):265-278. doi:10.1177/0333102415583989
7. Billman GE. Heart Rate Variability – A Historical Perspective. Front Physiol. 2011;2. doi:10.3389/fphys.2011.00086
8. Billman GE, Huikuri HV, Sacha J, Trimmel K. An introduction to heart rate variability: methodological considerations and clinical applications. Front Physiol. 2015;6. doi:10.3389/fphys.2015.00055
9. Thayer JF, Sternberg E. Beyond Heart Rate Variability. Annals of the New York Academy of Sciences. 2006;1088(1):361-372. doi:10.1196/annals.1366.014
10. 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. Neuroscience & Biobehavioral Reviews. 2012;36(2):747-756. doi:10.1016/j.neubiorev.2011.11.009
11. Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology. 2018;129(2):343-366. doi:10.1097/ALN.0000000000002130
12. Gockel M, Lindholm H, Niemistö L, Hurri H. Perceived disability but not pain is connected with autonomic nervous function among patients with chronic low back pain. Journal of rehabilitation medicine. 2008;40(5):355-358. doi:10.2340/16501977-0172

Presenting Author

Karin Steere

Poster Authors

Karin Steere

DPT, PhD

University of Puget Sound

Lead Author

E-mail

Ilsa Teppo

University of Puget Sound

Lead Author

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Mimi Chiquet

University of Puget Sound

Lead Author

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Olivia Saunders

University of Puget Sound

Lead Author

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Shannon Boyd

University of puget sound

Lead Author

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Kaitlyn Nguyen

University of Puget Sound

Lead Author

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Kellie Hirotsu

University of Puget Sound

Lead Author

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Topics

  • Mechanisms: Biological-Systems (Physiology/Anatomy)