Cardiovascular activity and chronic pain severity

Neurogastroenterology Motil

2019

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Background Different physical exercise interventions for pain and other related symptoms largely follow non‐personalized guidelines and show a high degree of variability in outcome. These interventions are considered to have different pathways toward improvement in autonomic regulation of energy metabolism. The current pilot study was conducted to assess the predictive value of individual cardiovascular (CV) activity markers at rest to predict clinical outcomes for two popular exercise‐based interventions (walking and yoga) in patients with Irritable Bowel Syndrome (IBS). Methods Twenty‐seven adult participants with IBS were randomly assigned to a 16‐biweekly Iyengar yoga or walking program. They completed pre‐ and post‐treatment assessments on IBS symptom severity, affective and somatic complaints, and various measures of resting autonomic function including blood pressure (BP), heart rate and its variability, baroreceptor sensitivity (BRS) to activations and inhibitions with gains of brady‐ and tachycardiac baro‐responses, and BP start points for these spontaneous baroreflexes. Results Pretreatment BRS was differentially related to clinical response for the treatment groups. Specifically, a significant decrease in pain severity was found in response to yoga for those participants who had lower resting BRS to activations, but decreased pain severity was associated with higher resting BRS for those in the walking group. The effect was not related to affective symptom relief. Other CV measures showed similar associations with clinical outcomes for both groups. Conclusions The data suggest therefore that CV based phenotypes may be useful in personalizing clinical interventions for IBS. They may also point to autonomic mechanisms that are targets for such interventions.

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Cardiovascular phenotyping for personalized lifestyle treatments of chronic abdominal pain in Irritable Bowel Syndrome: A randomized pilot study

Neurogastroenterology Motil

2019

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“…A finding of higher systolic blood pressure level in this sample of IBS patients is consistent with other studies that found that a systolic blood pressure increase in response to rectal pain stimulation was greater and prolonged in patients with IBS compared to healthy controls and that chronic pain is a significant predictor of increased blood pressure beyond the effects of traditional demographic risk [18,19,37]. Sustained increase of blood pressure level is considered to be an indicator of a pain regulation (‘pain killer’) mechanism [38–40]. In the present study, this pain alleviating mechanism associated with a diastolic blood pressure increase was affirmed and supported a recent finding of the impact of baroreflex function on endogenous control of acute pain coupled mainly with a diastolic blood pressure increase [41].…”

Section: Discussionsupporting

confidence: 83%

“…From an evolutionary viewpoint, this adaptation ‘blood pressure’ mechanism may help alleviate a recovery of physical functioning after impairments. Difference in effect size with respect to blood pressure measures obtained in office and laboratory may be explained by either the moderation effect of arousal variations between different settings [23,40,49,50] or worse accuracy of non-invasive beat-to-beat monitors in measuring absolute levels of blood pressure [51]. …”

Section: Discussionmentioning

confidence: 99%

Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices

et al. 2016

Physiology & Behavior

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Objective This study was conducted to present evidence of differences in autonomic regulation of cardiovascular activity and its role in the severity of specific (disease-related) and non-specific (negative affect and chronic pain-related) symptoms in individuals with Irritable Bowel Syndrome (IBS). Methods Seventy-eight female patients with IBS and 27 healthy women age 18–62 years were assessed for IBS symptoms, negative affect, and baroreceptor sensitivity (BRS), blood pressure (BP), heart rate, and heart rate variability (HRV) at rest. Direct and indirect regression effects were examined with application of the bootstrap procedure to validate findings. Results IBS was reliably related to lower resting BRS, higher BP, and higher negative affect compared to healthy controls. Longer disease duration (chronicity) was related to BRS decrease coupled with systolic BP increase (95% CIs = -0.14 to -0.01). Three autonomic mechanisms associated with BRS decrease were found to further regulate severity of IBS symptoms. Lower BRS was related to higher IBS severity in general if the effect was transferred through the decrease of low frequency power of HRV (e.g., 95% CIs = -0.039 to -0.001 for abdominal pain severity). However, lower BRS was related to lower IBS severity in general if the effect was transferred through diastolic BP increase (95% CIs = 0.01 to 0.11 for abdominal pain severity). Lower BRS was related to higher abdominal pain severity coupled with high negative affect if the effect was transferred through the decrease of higher frequency power of HRV (95% CIs = -0.026 to -0.003). Conclusions These findings indicate that different cardiovascular mechanisms are associated with IBS development and the increase and decrease of severity of IBS symptoms. Their assessment suggests ways to personalize treatment of IBS.

“…Activity of the autonomic nervous system is altered in chronic pain disorders in general including chronic visceral pain disorders such as irritable bowel syndrome (IBS) . In most previous studies, these alterations have been investigated using traditional indicators of CV system regulation such as baroreflex sensitivity (BRS), heart rate variability (HRV), and BP .…”

Section: Introductionmentioning

confidence: 99%

Asymmetries in reciprocal baroreflex mechanisms and chronic pain severity: Focusing on irritable bowel syndrome

Neurogastroenterology Motil

et al. 2017

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