The Autonomic Nervous System and Pain

Haugen, Frederick P.

doi:10.1097/00000542-196807000-00022

Cited by 20 publications

(7 citation statements)

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“…effective in blocking the small but diffuse visceral component of pain ( 14). Our results therefore suggest that attempting a complete peripheral somatic and visceral blockade with local anaesthetics may not be feasible, since we used a very large dose of bupivacaine, 862.5 mg in 12 h. Few studies on postoperative pain have attempted to assess the patient's ability to mobilise ( 15-1 7).…”

Section: Pn-wmentioning

confidence: 95%

Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double‐blind randomised study

Hamid

Scott

Sutcliffe

et al. 1992

Acta Anaesthesiol Scand

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In this double-blind trial, we observed the effect of intermittent wound infiltration with local anaesthetic plus continuous coeliac plexus blockade on postoperative pain relief, pulmonary function, the neuroendocrine and acute phase protein response following upper abdominal surgery. In Group A (n = 10) patients received bupivacaine intermittently into the wound and continuously into the coeliac plexus following an initial bolus. A total of 862.5 mg of bupivacaine was used over 12 h with no observed toxicity. Group B (n = 10) received equal volumes of saline. Although pain relief was poor in both groups, the bupivacaine group used less morphine postoperatively and had lower pain scores than the saline group 4 h after operation (P less than 0.05). Pulmonary function was significantly reduced in both groups with no statistical difference between the two. Significant reductions in serum glucose and cortisol were achieved (P less than 0.05), suggesting that afferent neural blockade was partially effective in attenuating the neuroendocrine response. However, the postoperative rise in interleukin-6 was not affected by this technique. It is concluded that total afferent neural blockade cannot be achieved with peripheral wound and coeliac plexus administration of relatively large doses of local anaesthetic during upper abdominal surgery.

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Section: Pn-wmentioning

confidence: 95%

Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double‐blind randomised study

Hamid

Scott

Sutcliffe

et al. 1992

Acta Anaesthesiol Scand

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“…However, it notoriously commonly converts to disabling chronic conditions such as low back pain, fibromyalgia, or other complex pain syndromes [2, 3]. Although much remains to be studied in terms of the mechanisms of pain [1, 2], the interconnections between the autonomic nervous system (ANS) and pain have long been recognized [4]. Being able to adjust autonomic functions such as heart rate (HR), the ANS contributes to maintaining physiological equilibrium under changing conditions.…”

Section: Introductionmentioning

confidence: 99%

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

Oura

Hautala

Kiviniemi

et al. 2019

BMC Musculoskelet Disord

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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.

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“…Chronic pain conditions have been linked to alterations in both the central and peripheral components of the nervous system 5,6 . The autonomic nervous system (ANS) adjusts autonomic functions according to pain and other stressors 7 and plays an essential role in the modulation of pain perception 8 . Measurements of heart rate variability (HRV) and baroreflex sensitivity (BRS) provide non-invasive methods for assessing ANS [9][10][11][12][13] ; decreased vagal activity and increased sympathetic activity indicate abnormal cardiovascular autonomic function [14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

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

Oura

Hautala

Kiviniemi

et al. 2019

Spine

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In a large general population sample of Northern Finns (n = 1667-3398), we found that the 15-year trajectories of low back pain and sciatica did not have a consistent independent association with cardiovascular autonomic function. Pain trajectories & cardiovascular autonomic function KEY POINTS • We examined whether 15-year trajectories of low back pain (LBP) and sciatica were associated with cardiovascular autonomic parameters in a large general population sample from Northern Finland (n = 1667-3398). • LBP and sciatica were variably associated with higher heart rate, lower rMSSD [root mean square of successive differences in beat-to-beat intervals], higher systolic blood pressure variability, and lower baroreflex sensitivity in the crude models, but most of these associations were attenuated by adjustments. • We conclude that the 15-year trajectories of LBP and sciatica do not have an independent association with cardiovascular autonomic function among the general Northern Finnish population. Pain trajectories & cardiovascular autonomic function STRUCTURED ABSTRACT Study Design: A population-based cohort study. Objective: To examine whether 15-year trajectories of low back pain (LBP) and sciatica are associated with cardiovascular autonomic function in a large general population sample. Summary of Background Data: Previous studies using mainly small patient samples have suggested that LBP and sciatica are associated with abnormal cardiovascular autonomic function, namely altered heart rate variability (HRV) and baroreflex sensitivity (BRS). We examined this association in a large general population sample. Methods: The data collections of the Northern Finland Birth Cohort 1966 consisted of pain questionnaires at 31 and 46 years (history of LBP, sciatica and other musculoskeletal pains during the previous year; yes/no for each) and measurements of HRV and BRS at 46 years (heart rate,HR; root mean square of successive differences in beat-to-beat intervals,rMSSD; low-frequency systolic blood pressure variability,SBPV; crossspectral baroreflex sensitivity,BRS; each while seated and standing). The data collections also comprised several confounders. Trajectories for LBP, sciatica and both together ('no pain', 'decreasing', 'increasing', 'long-term pain') were constructed and general linear models were used to perform comparisons between trajectories (for HR/rMSSD,n=3398; for SBPV/BRS,n=1667). Results: In the crude models, LBP and sciatica were associated with higher HR, lower rMSSD, higher SBPV and lower BRS, but these associations were mostly attenuated by adjustments. Regarding both LBP and sciatica, only the 'increasing' trajectory was associated with two of the eight outcomes (standing SBPV, seated BRS) after adjustments. Regarding LBP, the 'increasing' trajectory was associated with three (standing SBPV, seated BRS, standing BRS), the 'long-term pain' trajectory with one (standing BRS), and the 'decreasing' trajectory with one outcome (seated SBPV) after adjustments. Sciatica showed no association with the outc...

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The Autonomic Nervous System and Pain

Cited by 20 publications

References 0 publications

Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double‐blind randomised study

Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double‐blind randomised study

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

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

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