Interacting influences of gender and chronic pain status on parasympathetically mediated heart rate variability in adolescents and young adults

Abstract

Considerable research links chronic pain to autonomic nervous system (ANS) dysfunction, specifically low heart rate variability (HRV) mediated by reduced parasympathetic activity. However, little is known about factors that influence ANS function in chronic pain. The ANS is the primary pathway for brain–gut communication, making it of particular interest in gastrointestinal disorders, such as irritable bowel syndrome, characterized by functional abdominal pain (FAP). We evaluated the relation of sex, pain severity, and psychological stress to ANS function in adolescents/young adults from a database of pediatric FAP and control participants enrolled 8 years earlier in a prospective study of pain. At follow-up in adolescence/young adulthood (Mean age = 19.46, SD = 3.48), we classified participants as Pain-Remit (n = 130), Pain-Persist (n = 96), and pain-free controls (n = 123). We recorded electrocardiogram data at rest and during laboratory stressors. Results demonstrated significantly lower HRV in Pain-Persist females compared with Pain-Remit females, female controls, and all males regardless of pain category. Spectral analysis of electrocardiogram showed that Pain-Persist females had reduced power in the high frequency domain of cardiac activity, ie, reduced parasympathetic “braking” of sympathetic activity, both at rest and during stress. Pain-Remit females exhibited levels of autonomic imbalance intermediate between those of females with persistent FAP and all other participants. Parasympathetically mediated low HRV in young women with persistent FAP may reflect a peripheral mechanism (eg, gut dysfunction) or a central nervous system mechanism (eg, pain amplification or poor emotion self-regulation) involving prolonged sympathetic activation.

Electrogastrographic and autonomic nervous system responses to solid and liquid meals in youth with functional dyspepsia

“…It is not clear whether this rigidity is a primary underlying pathophysiologic mechanism or possibley due to chronic stress. The autonomic system rigidity demonstrated in the current study has been previously reported in children with functional abdominal pain when undergoing a psychologic stress task . If it is a primary mechanism, it may be amendable to modalities such as HRV biofeedback.…”

“…This was true whether assessed as the average over the en- task. 26 If it is a primary mechanism, it may be amendable to modalities such as HRV biofeedback. As the rigidity might be due to chronic stress, future studies should address whether it reverses with treatments directed at stress management and importantly, whether any reversal is associated with symptom improvement.…”

The Relationship Between Heart Rate Variability, Psychological Flexibility, and Pain in Neurofibromatosis Type 1

“…18 Research has demonstrated that patients with chronic pain experience self-regulatory depletion, 9,19 which has been theorized to limit the availability of other personal resources (eg, motivation, planning) needed to persist with daily activities or respond adaptively to stress. 18,41 This relationship is exemplified in the current data through a mediational model in which HF-HRV directly influences psychological flexibility, and that, in turn, affects everyday behavior in the context of pain.…”

“…While the latter has not been studied directly, research suggests that, among patients with chronic pain, low HRV is associated with poor emotional reactivity, 8 poor adaptability to internal and external demands, 19 and weak behavioral persistence, 18 which are proximate behaviors associated with psychological flexibility. 20 …”

Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review

“…HRV is a commonly used index in gastroenterology, as it reflects the unbalance between the primary excitatory and inhibitory body systems [104]. ANS is the main communications pathway between brain and intestine, hence it is of particular interest for gastrointestinal disorders, as it is the case of irritable intestine syndrome, which is characterized by a functional abdominal pain [105]. Defining the gravity of the pain according to its duration and intensity, a lower HRV has been related with a higher gravity of abdominal pain in these patients [28,106,107].…”