Musculoskeletal pains and cardiovascular autonomic function in the general Northern Finnish population

Abstract

BackgroundHeart rate variability (HRV) and baroreflex sensitivity (BRS) measurements provide means for the objective assessment of cardiovascular autonomic function. As previous studies have associated chronic pain with abnormal autonomic function, we aimed to characterize the relationship between the number of musculoskeletal pain sites (NPS), pain intensity, and cardiovascular autonomic function among the population-based Northern Finland Birth Cohort 1966.MethodsAt the age of 46, cohort members self-reported their musculoskeletal pains (enabling the determination of NPS [0–8] and pain intensity [Numerical Rating Scale, NRS, 0–10]) and underwent clinical assessments of cardiovascular autonomic function in seated and standing positions (HRV variables: heart rate [HR] and root mean square of successive differences in beat-to-beat intervals [rMSSD] for the entire cohort; BRS variables: low-frequency systolic blood pressure variability [SBPV] and cross-spectral baroreflex sensitivity [BRS] for those attending the examination in Oulu, Finland). Extensive confounder data were also collected (body mass index, physical activity, smoking, Hopkins Symptom Checklist-25, comorbidities, and medications). The full samples included 4186 and 2031 individuals (HRV and BRS samples, respectively). Three subanalyses focused on individuals with intense and frequent pain, individuals with symptoms of depression and anxiety, and the relationship between pain intensity and autonomic parameters.ResultsLinear regression models showed varying associations between NPS, pain intensity, and cardiovascular autonomic parameters. However, after all adjustments NPS was only associated with one outcome among women (BRS, standing: beta = − 0.015, p = 0.048) and two among men (HR, seated: beta = − 0.902, p = 0.003; HR, standing: beta = − 0.843, p = 0.014). Pain intensity was not associated with any outcome after full adjustments. Significant sex*pain interactions were found in the data.ConclusionsOur data suggest that musculoskeletal pain has, at most, a limited independent association with cardiovascular autonomic function. Future studies should carefully account for the potential confounders and sex interactions that this study revealed.Electronic supplementary materialThe online version of this article (10.1186/s12891-019-2426-2) contains supplementary material, which is available to authorized users.

Are 15-Year Trajectories of Low Back Pain and Sciatica Associated With Cardiovascular Autonomic Function in the General Population?

“…In our data, the discordance between the results drawn from the crude and adjusted models suggests that the association between LBP, sciatica and cardiovascular autonomic function is greatly confounded and/or mediated by external factors such as sex, BMI, LTPA, smoking status, other musculoskeletal pains, somatic and psychiatric comorbidity and ANS-related medication. Two previous papers have obtained similar findings 24,25 . Thus, in order to reveal the independent association between pain and ANS function, future studies should aim to record these background characteristics at the data collection stage, and use these variables to control for the potential confounder effects.…”

“…Interestingly, another recent meta-analysis found a consistent, moderate-to-large effect of decreased HRV in chronic pain, suggesting a decrease in parasympathetic activation in individuals with pain 14 . In light of several smaller studies, this association seems to also concern LBP and sciatica 12,13,21,22 , although previous studies have reported the association between musculoskeletal pain and ANS function to be potentially confounded by lifestyle factors and/or comorbidities 24,25 . The present study aimed to supplement the previous investigations of LBP, sciatica and cardiovascular autonomic function by constructing 15-year pain trajectories to be assessed against both HRV and BRS parameters in a general population sample.…”

“…As for LBP and sciatica, several smaller studies have suggested impaired cardiovascular autonomic function 12,13,21,22 , although the coherence and reliability of these reports is reduced by contradicting findings 23 , limited Pain trajectories & cardiovascular autonomic function 2 sample sizes, use of patient samples, varying definitions of pain, and varying methods for assessing ANS function. Moreover, previous studies have reported the association between musculoskeletal pain and ANS function to be potentially confounded by lifestyle factors and/or comorbidities, and suggested that these factors should be carefully accounted for in future studies 24,25 . Thus, there is a need for large-scale studies on the subject.…”

Exploring the non-communicable disease (NCD) network of multi-morbid individuals in India: A network analysis

“…Musculoskeletal disorders comprise of a wide range of diseases and conditions, most common include tendonitis, osteoarthritis and rheumatoid arthritis. While some studies report a negative association between osteoarthritis (a musculoskeletal disorder) and hypertension [28,29]; others report a positive association between hypertension and musculoskeletal complaints, like rheumatoid arthritis and musculoskeletal pain [30][31][32]. These studies suggest that musculoskeletal pain affect the Autonomic Nervous System (ANS) that controls the cardiovascular activities and regulates blood pressure levels and heart rate, and this might interfere with both diastolic and systolic blood pressure levels [31].…”

“…While some studies report a negative association between osteoarthritis (a musculoskeletal disorder) and hypertension [28,29]; others report a positive association between hypertension and musculoskeletal complaints, like rheumatoid arthritis and musculoskeletal pain [30][31][32]. These studies suggest that musculoskeletal pain affect the Autonomic Nervous System (ANS) that controls the cardiovascular activities and regulates blood pressure levels and heart rate, and this might interfere with both diastolic and systolic blood pressure levels [31]. On the other hand, diabetes mellitus and hypertension are stated to have bi-directional relationship with shared risk factors.…”