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Findeisen K, Guymer E, Littlejohn G. Neuroinflammatory and Immunological Aspects of Fibromyalgia. Brain Sci 2025; 15:206. [PMID: 40002538 PMCID: PMC11852494 DOI: 10.3390/brainsci15020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 02/10/2025] [Accepted: 02/13/2025] [Indexed: 02/27/2025] Open
Abstract
Fibromyalgia is a common, high-impact condition of chronic widespread pain and sensory dysfunction associated with altered central and peripheral sensory processing. A growing body of evidence supports the role of neuroinflammation and immune changes in fibromyalgia, and a narrative review of this literature was undertaken. Published data suggest that the interactions between the neural pain networks and the immune system in fibromyalgia appear to be bidirectional and operate both centrally and peripherally. There is a growing focus on processes occurring in the dorsal root ganglia and the role of maladaptive microglial cell activation. Ongoing insight into neuroinflammatory mechanisms in fibromyalgia opens potential avenues for the development of mechanism-based therapies in what is, at present, a challenging-to-manage condition.
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Affiliation(s)
- Kate Findeisen
- Department of Rheumatology, Monash Health, Melbourne, VIC 3168, Australia; (K.F.); (G.L.)
| | - Emma Guymer
- Department of Rheumatology, Monash Health, Melbourne, VIC 3168, Australia; (K.F.); (G.L.)
- Department of Medicine, Monash University, Melbourne, VIC 3800, Australia
| | - Geoffrey Littlejohn
- Department of Rheumatology, Monash Health, Melbourne, VIC 3168, Australia; (K.F.); (G.L.)
- Department of Medicine, Monash University, Melbourne, VIC 3800, Australia
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Gomez-Alvaro MC, Gusi N, Cano-Plasencia R, Leon-Llamas JL, Murillo-Garcia A, Melo-Alonso M, Villafaina S. Effects of Different Transcranial Direct Current Stimulation Intensities over Dorsolateral Prefrontal Cortex on Brain Electrical Activity and Heart Rate Variability in Healthy and Fibromyalgia Women: A Randomized Crossover Trial. J Clin Med 2024; 13:7526. [PMID: 39768449 PMCID: PMC11728266 DOI: 10.3390/jcm13247526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/05/2024] [Accepted: 12/09/2024] [Indexed: 01/16/2025] Open
Abstract
People with fibromyalgia (FM) exhibit alterations in brain electrical activity and autonomic modulation compared to healthy individuals. Objectives: This study aimed to investigate transcranial direct current stimulation (tDCS) effects on brain electrocortical activity and heart rate variability (HRV), specifically targeting the dorsolateral prefrontal cortex in both healthy controls (HC) and FM groups, to identify potential differences in the responses between these groups, and to compare the effectiveness of two distinct tDCS intensities (1 mA and 2 mA) against a sham condition. Methods: Electroencephalography and electrocardiogram signals were recorded pre- and post-tDCS intervention. All participants underwent the three conditions (sham, 1 mA, and 2 mA) over three separate weeks, randomized in order. Results: No statistically significant baseline differences were found in the investigated HRV variables. In the FM group, 1 mA tDCS induced significant increases in LF, LF/HF, mean HR, SDNN, RMSSD, total power, SD1, SD2, and SampEn, and a decrease in HF, suggesting a shift toward sympathetic dominance. Additionally, 2 mA significantly increased SampEn compared to sham and 1 mA. In the HC group, sham increased DFA1 compared to 1 mA, and 2 mA induced smaller changes in SampEn relative to sham and 1 mA. No significant differences were found between FM and HC groups for any tDCS intensity. Conclusions: The effects of dlPFC-tDCS on HRV are intensity- and group-dependent, with the FM group exhibiting more pronounced changes at 1 mA and 2 mA. These findings emphasize the need for individualized stimulation protocols, given the variability in responses across groups and intensities.
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Affiliation(s)
- Mari Carmen Gomez-Alvaro
- Grupo de Investigación en Actividad Física Calidad de Vida y Salud (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain; (M.C.G.-A.); (J.L.L.-L.); (A.M.-G.); (S.V.)
- Instituto Universitario de Investigación e Innovación en Deporte (INIDE), Universidad de Extremadura, Av. de la Universidad s/n, 10003 Cáceres, Spain
| | - Narcis Gusi
- Grupo de Investigación en Actividad Física Calidad de Vida y Salud (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain; (M.C.G.-A.); (J.L.L.-L.); (A.M.-G.); (S.V.)
- Instituto Universitario de Investigación e Innovación en Deporte (INIDE), Universidad de Extremadura, Av. de la Universidad s/n, 10003 Cáceres, Spain
| | | | - Juan Luis Leon-Llamas
- Grupo de Investigación en Actividad Física Calidad de Vida y Salud (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain; (M.C.G.-A.); (J.L.L.-L.); (A.M.-G.); (S.V.)
- Instituto Universitario de Investigación e Innovación en Deporte (INIDE), Universidad de Extremadura, Av. de la Universidad s/n, 10003 Cáceres, Spain
| | - Alvaro Murillo-Garcia
- Grupo de Investigación en Actividad Física Calidad de Vida y Salud (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain; (M.C.G.-A.); (J.L.L.-L.); (A.M.-G.); (S.V.)
- Instituto Universitario de Investigación e Innovación en Deporte (INIDE), Universidad de Extremadura, Av. de la Universidad s/n, 10003 Cáceres, Spain
| | - Maria Melo-Alonso
- Grupo de Investigación en Actividad Física Calidad de Vida y Salud (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain; (M.C.G.-A.); (J.L.L.-L.); (A.M.-G.); (S.V.)
- Instituto Universitario de Investigación e Innovación en Deporte (INIDE), Universidad de Extremadura, Av. de la Universidad s/n, 10003 Cáceres, Spain
| | - Santos Villafaina
- Grupo de Investigación en Actividad Física Calidad de Vida y Salud (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain; (M.C.G.-A.); (J.L.L.-L.); (A.M.-G.); (S.V.)
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Guichard L, An X, Neylan TC, Clifford GD, Li Q, Ji Y, Macchio L, Baker J, Beaudoin FL, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Gentile NT, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Sheridan JF, Harte SE, Ressler KJ, Koenen KC, Kessler RC, McLean SA. Heart rate variability wrist-wearable biomarkers identify adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure. Psychiatry Res 2024; 342:116260. [PMID: 39549594 PMCID: PMC11617258 DOI: 10.1016/j.psychres.2024.116260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 10/15/2024] [Accepted: 11/05/2024] [Indexed: 11/18/2024]
Abstract
Adverse posttraumatic neuropsychiatric sequelae (APNS) are common after traumatic events. We examined whether wrist-wearable devices could provide heart rate variability (HRV) biomarkers for recovery after traumatic stress exposure in a large socioeconomically disadvantaged cohort. Participants were enrolled in the emergency department within 72 hours after a traumatic event as part of the AURORA (Advancing Understanding of RecOvery afteR traumA) multicenter prospective observational cohort study and followed over 6 months. HRV biomarkers were derived and validated for associations with specific APNS symptoms at a point in time and changes in symptom severity over time. Sixty-four HRV characteristics were derived and validated as cross-sectional biomarkers of APNS symptoms, including pain (26), re-experiencing (8), somatic (7), avoidance (7), concentration difficulty (6), hyperarousal (5), nightmares (1), anxiety (1), and sleep disturbance (3). Changes in 22 HRV characteristics were derived and validated as biomarkers identifying changes in APNS symptoms, including reexperiencing (11), somatic (3), avoidance (2), concentration difficulty (1), hyperarousal (1), and sleep disturbance (4). Changes in HRV variables over time predicted symptom improvement (PPV 0.68-0.87) and symptom worsening (NPV 0.71-0.90). HRV biomarkers collected from wrist-wearable devices may have utility as screening tools for APNS symptoms that occur after traumatic stress exposure in high-risk populations.
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Affiliation(s)
- Lauriane Guichard
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA.
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Qiao Li
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Lindsay Macchio
- Institute for Trauma Recovery, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Justin Baker
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, 02930, USA; Department of Emergency Medicine, Brown University, Providence, RI, 02930, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, 48202, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA; The Many Brains Project, Belmont, MA, 02478, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, 43210, USA; Ohio State University College of Nursing, Columbus, OH, 43210, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19121, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Jefferson Einstein hospital, Jefferson Health, Philadelphia, PA, 19141, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, 48202, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
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Troisi G, Di Giacomo P, Forte G, Langher V, Casagrande M, Di Paolo C. The "Wear and Tear" of the Organism in Temporomandibular Disorders: A Pilot Study Investigating the Effects of Allostatic Load on Heart Rate Variability and Inhibitory Control. J Pers Med 2024; 14:787. [PMID: 39201979 PMCID: PMC11355141 DOI: 10.3390/jpm14080787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024] Open
Abstract
Temporomandibular disorders (TMDs) are the most common cause of non-dental chronic pain in the orofacial region and can chronically increase the activity of the allostatic systems. The allostatic overload related to these conditions causes an autonomic dysregulation, reflected by a reduction in heart rate variability (HRV). Nevertheless, chronic pain in these patients could cause more severe health consequences, such as those related to cognitive functioning. Deficits in executive control have been associated with allostatic overload and could negatively affect pain management strategies. This study aimed to investigate the effects of chronic pain on HRV and both motor and cognitive inhibition (assessed with the Go/No-Go and Stroop tasks, respectively) in a sample of 14 patients with TMD and 15 healthy controls. Consistent with our hypothesis and the previous literature, the group with TMD had a lower resting HRV, but no differences were found between the groups in inhibition. Furthermore, the results showed that the effects of HRV on cognitive inhibition can be mediated by pain intensity. Finally, a correlation between age and HRV emerged in patients with TMD but not in healthy controls.
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Affiliation(s)
- Giovanna Troisi
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy
- Department of Experimental Psychology, Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - Paola Di Giacomo
- Department of Oral and Maxillo-Facial Sciences, Policlinico Umberto I, 00161 Rome, Italy
| | - Giuseppe Forte
- Department of Dynamic, Clinical Psychology and Health Studies, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Viviana Langher
- Department of Dynamic, Clinical Psychology and Health Studies, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Maria Casagrande
- Department of Dynamic, Clinical Psychology and Health Studies, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Carlo Di Paolo
- Department of Oral and Maxillo-Facial Sciences, Policlinico Umberto I, 00161 Rome, Italy
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Weston EB, Hassett AL, Khan SN, Weaver TE, Marras WS. Cognitive dissonance increases spine loading in the neck and low back. ERGONOMICS 2023; 66:2133-2147. [PMID: 36861457 DOI: 10.1080/00140139.2023.2186323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Cognitive dissonance refers to a state where two psychologically inconsistent thoughts, behaviours, or attitudes are held at the same time. The objective of this study was to explore the potential role of cognitive dissonance in biomechanical loading in the low back and neck. Seventeen participants underwent a laboratory experiment involving a precision lowering task. To establish a cognitive dissonance state (CDS), study participants were provided negative feedback on their performance running counter to a pre-established expectation that their performance was excellent. Dependent measures of interest were spinal loads in the cervical and lumbar spines, calculated via two electromyography-driven models. The CDS was associated with increases to peak spinal loads in the neck (11.1%, p < .05) and low back (2.2%, p < .05). A greater CDS magnitude was also associated with a greater spinal loading increase. Therefore, cognitive dissonance may represent a risk factor for low back/neck pain that has not been previously identified.Practitioner summary: Upon establishing a cognitive dissonance state in a group of participants, spinal loading in the cervical and lumbar spines were increased proportional to the magnitude of the cognitive dissonance reported. Therefore, cognitive dissonance may represent a risk factor for low back and neck pain that has not been previously identified.
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Affiliation(s)
- Eric B Weston
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
| | - Afton L Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Safdar N Khan
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Orthopedics, The Ohio State University, Columbus, OH, USA
| | - Tristan E Weaver
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
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Biral TM, de Souza Cavina AP, Junior EP, Filho CATT, Vanderlei FM. Effects of remote ischemic conditioning on conditioned pain modulation and cardiac autonomic modulation in women with knee osteoarthritis: placebo-controlled randomized clinical trial protocol. Trials 2023; 24:502. [PMID: 37550703 PMCID: PMC10405415 DOI: 10.1186/s13063-023-07527-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND It is estimated that over 240 million people worldwide have osteoarthritis, which is a major contributor to chronic pain and central changes in pain processing, including endogenous pain modulation. The autonomic nervous system plays a crucial role in the pain regulatory process. One of the main mechanisms of remote ischemic conditioning is neuronal signaling from the preconditioned extremity to the heart. This study aims to analyze the acute effect of remote ischemic conditioning on local pain, conditioned pain modulation, and cardiac autonomic control in women with knee osteoarthritis and to see if there is a correlation between them. METHODS Women more than 50 years with knee osteoarthritis diagnosed according to the American College of Rheumatology criteria in the postmenopausal period will be considered eligible. The study will have blind randomization, be placebo-controlled, and be balanced in a 1:1 ratio. The total of 44 participants will be divided into two groups (22 participants per group): (i) remote ischemic conditioning and (ii) placebo remote ischemic conditioning. Protocol consisting of four cycles of total ischemia, followed immediately by four cycles of 5 min of vascular reperfusion, totaling 40 min. The primary outcomes in the protocol are conditioned pain modulation, which has the pressure pain threshold (kgf/cm2) as its primary outcome measure, and cardiac autonomic modulation, which has the indices found in heart rate variability as its primary outcome measure. Comparisons will be performed using generalized linear mixed models fitted to the data. For correlation, the Pearson or Spearman test will be used depending on the normality of the data. All analyses will assume a significance level of p < 0.05. DISCUSSION It is believed that the results of this study will present a new perspective on the interaction between the pain processing system and the cardiovascular system; they will provide the professional and the patient with a greater guarantee of cardiovascular safety in the use of the intervention; it will provide knowledge about acute responses and this will allow future chronic intervention strategies that aim to be used in the clinical environment, inserted in the multimodal approach, for the treatment of osteoarthritis of the knee. TRIAL REGISTRATION ClinicalTrials.gov NCT05059652. Registered on 30 August 2021. Last update on 28 March 2023.
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Affiliation(s)
- Taíse Mendes Biral
- Postgraduate Program in Movement Sciences, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, SP, Brazil.
| | - Allysiê Priscilla de Souza Cavina
- Postgraduate Program in Physiotherapy, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, SP, Brazil
| | - Eduardo Pizzo Junior
- Postgraduate Program in Movement Sciences, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, SP, Brazil
| | - Carlos Alberto Toledo Teixeira Filho
- Postgraduate Program in Movement Sciences, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, SP, Brazil
| | - Franciele Marques Vanderlei
- Postgraduate Program in Movement Sciences, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, SP, Brazil
- Department of Physiotherapy, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, SP, Brazil
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7
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Moens M, Billet B, Molenberghs G, De Smedt A, Pilitsis JG, De Vos R, Hanssens K, Billot M, Roulaud M, Rigoard P, Goudman L. Heart rate variability is not suitable as a surrogate marker for pain intensity in patients with chronic pain. Pain 2023; 164:1741-1749. [PMID: 36722463 DOI: 10.1097/j.pain.0000000000002868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/03/2023] [Indexed: 02/02/2023]
Abstract
ABSTRACT The search towards more objective outcome measurements and consequently surrogate markers for pain started decades ago; however, no generally accepted biomarker for pain has qualified yet. The goal is to explore the value of heart rate variability (HRV) as surrogate marker for pain intensity chronic pain setting. Pain intensity scores and HRV were collected in 366 patients with chronic pain, through a cross-sectional multicenter study. Pain intensity was measured with both the visual analogue scale and numeric rating scale, whereas 16 statistical HRV parameters were derived. Canonical correlation analysis was performed to evaluate the correlation between the dependent pain variables and the HRV parameters. Surrogacy was determined for each HRV parameter with point estimates between 0 and 1 whereby values close to 1 indicate a strong association between the surrogate and the true endpoint at the patient level. Weak correlations were revealed between HRV parameters and pain intensity scores. The highest surrogacy point estimate was found for mean heart rate as marker for average pain intensity on the numeric rating scale with point estimates of 0.0961 (95% confidence interval [CI] 0.0384-0.1537) and 0.0209 (95% CI 0-0.05) for patients without medication use and with medication, respectively. This study indicated that HRV parameters as separate entities are no suitable surrogacy candidates for pain intensity, in a population of chronic pain patients. Further potential surrogate candidates and clinical robust true endpoints should be explored, to find a surrogate measure for the highly individual pain experience.
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Affiliation(s)
- Maarten Moens
- STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bart Billet
- STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Brussels, Belgium
- Pain Clinic, AZ Delta, Roeselare, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Diepenbeek, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Catholic University of Leuven, Leuven, Belgium
| | - Ann De Smedt
- STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | | | | | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Lisa Goudman
- STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
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8
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Lagatta DC, Fassini A, Terzian AL, Corrêa FMA, Resstel LBM. The medial prefrontal cortex and the cardiac baroreflex activity: physiological and pathological implications. Pflugers Arch 2023; 475:291-307. [PMID: 36695881 DOI: 10.1007/s00424-022-02786-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
The cardiac baroreflex is an autonomic neural mechanism involved in the modulation of the cardiovascular system. It influences the heart rate and peripheral vascular resistance to preserve arterial blood pressure within a narrow variation range. This mechanism is mainly controlled by medullary nuclei located in the brain stem. However, supramedullary areas, such as the ventral portion of medial prefrontal cortex (vMPFC), are also involved. Particularly, the glutamatergic NMDA/NO pathway in the vMPFC can facilitate baroreflex bradycardic and tachycardic responses. In addition, cannabinoid receptors in this same area can reduce or increase those cardiac responses, possibly through alteration in glutamate release. This vMPFC network has been associated to cardiovascular responses during stressful situations. Recent results showed an involvement of glutamatergic, nitrergic, and endocannabinoid systems in the blood pressure and heart rate increases in animals after aversive conditioning. Consequently, baroreflex could be modified by the vMPFC neurotransmission during stressful situations, allowing necessary cardiovascular adjustments. Remarkably, some mental, neurological and neurodegenerative disorders can involve damage in the vMPFC, such as posttraumatic stress disorder, major depressive disorder, Alzheimer's disease, and neuropathic pain. These pathologies are also associated with alterations in glutamate/NO release and endocannabinoid functions along with baroreflex impairment. Thus, the vMPFC seems to play a crucial role on the baroreflex control, either during pathological or physiological stress-related responses. The study of baroreflex mechanism under such pathological view may be helpful to establish causality mechanisms for the autonomic and cardiovascular imbalance found in those conditions. It can explain in the future the reasons of the high cardiovascular risk some neurological and neurodegenerative disease patients undergo. Additionally, the present work offers insights on the possible contributions of vMPFC dysfunction on baroreflex alterations, which, in turn, may raise questions in what extent other brain areas may play a role in autonomic deregulation under such pathological situations.
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Affiliation(s)
- Davi C Lagatta
- Faculty of Pharmaceutical Sciences, Food and Nutrition, Federal University of Mato Grosso do Sul, MS, 79070-900, Campo Grande, Brazil
| | - Aline Fassini
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Ana L Terzian
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Fernando M A Corrêa
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Leonardo B M Resstel
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil.
- Center for Interdisciplinary Research On Applied Neurosciences (NAPNA), Medical School of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil.
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9
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Coexistence of fibromyalgia syndrome and inflammatory rheumatic diseases, and autonomic cardiovascular system involvement in fibromyalgia syndrome. Clin Rheumatol 2023; 42:645-652. [PMID: 36151442 DOI: 10.1007/s10067-022-06385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
The spectrum of symptoms represented by fibromyalgia syndrome (FMS) has a profound effect on daily activities and impairs the quality of life. A considerable proportion of patients with inflammatory rheumatic diseases (IRDs) fulfill the FMS criteria, which can complicate the diagnosis, treatment, and follow-ups of IRD. In addition, the coexistence of FMS may cause unnecessary laboratory and radiological assessments. Several mechanisms have been proposed that may have a role in the etiopathogenesis of FMS, one of which is autonomic dysregulation. In studies evaluating cardiac autonomic dysfunction based on heart rate variability (HRV), there has been found to be a decrease in HRV and dominance of the sympathetic nervous system. Autonomic reactivity reflects modulations of several functions to overcome the existing state and conditions. Blunted autonomic reactivity has been found in some FMS patients, which makes it difficult for these patients to respond appropriately to unexpected stress sources that occur during daily living activities. Baroreceptor signals have an inhibitory influence on the central nervous system, and these impulses cause pain suppression. From this perspective, there are studies that have suggested the involvement of diminished baroreflex sensitivity in the etiology of FMS. The risk of endothelial dysfunction and increased arterial stiffness have been shown to occur in FMS patients due to autonomic dysfunction, sympathetic nervous system dominance, chronic stress, and pain. There is also evidence linking FMS with the risk of atrial and ventricular arrhythmias. Considering all these cardiovascular autonomic dysfunctions, tests that can confirm abnormalities should be performed when suspicion arises. There is a need for specific pharmacological and non-pharmacological treatment alternatives to be identified for subgroups of patients with cardiovascular system abnormalities. Key points • The frequency of FMS accompanying inflammatory rheumatic diseases is considerable and this coexistence leads to troubles in evaluating treatment response and determining appropriate medical treatment options in inflammatory rheumatic diseases. • Various cardiovascular autonomic abnormalities have been described in FMS patients. Among these, the most emphasized are autonomic dysfunction, the disruption of the balance between the sympathetic-parasympathetic nervous systems, blunted autonomic reactivity to acute stress, changes in baroreflex sensitivity, increased arterial stiffness, and electrophysiological alterations. • Autonomic cardiovascular dysfunction may be involved in the complex etiopathogenesis of the fibromyalgia syndrome and may trigger at least some symptoms.
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10
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Bossenger NR, Lewis GN, Rice DA, Shepherd D. The autonomic and nociceptive response to acute exercise is impaired in people with knee osteoarthritis. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100118. [PMID: 36711216 PMCID: PMC9873673 DOI: 10.1016/j.ynpai.2023.100118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Objectives An acute bout of exercise typically leads to short term exercise induced hypoalgesia (EIH), but this response is more variable in many chronic pain populations, including knee osteoarthritis (OA) and fibromyalgia (FM). There is evidence of autonomic nervous system (ANS) dysfunction in some chronic pain populations that may contribute to impaired EIH, but this has not been investigated in people with knee OA. The aim of this study was to assess the acute effects of isometric exercise on the nociceptive and autonomic nervous systems in people with knee OA and FM, compared to pain-free controls. Methods A cross-sectional study was undertaken with 14 people with knee OA, 13 people with FM, and 15 pain free controls. Across two experimental sessions, baseline recordings and the response of the nociceptive and autonomic nervous systems to a 5-min submaximal isometric contraction of the quadriceps muscle was assessed. The nociceptive system was assessed using pressure pain thresholds at the knee and forearm. The ANS was assessed using high frequency heart rate variability, cardiac pre-ejection period, and electrodermal activity. Outcome measures were obtained before and during (ANS) or immediately after (nociceptive) the acute bout of exercise. Results Submaximal isometric exercise led to EIH in the control group. EIH was absent in both chronic pain groups. Both chronic pain groups showed lower vagal activity at rest. Furthermore, people with knee OA demonstrated reduced vagal withdrawal in response to acute isometric exercise compared to controls. Sympathetic reactivity was similar across groups. Discussion The findings of reduced tonic vagal activity and reduced autonomic modulation in response to isometric exercise raise the potential of a blunted ability to adapt to acute exercise stress and modulate nociception in people with knee OA. The impairment of EIH in knee OA may, in part, be due to ANS dysfunction.
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Affiliation(s)
- Neil R. Bossenger
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gwyn N. Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Corresponding author at: Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - David A. Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Waitematā Pain Services, Department of Anaesthesiology and Perioperative Medicine, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Daniel Shepherd
- Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Ansuategui Echeita J, Schiphorst Preuper HR, Dekker R, Reneman MF. Central sensitization and functioning in patients with chronic low back pain: A cross-sectional and longitudinal study. J Back Musculoskelet Rehabil 2022; 35:1179-1190. [PMID: 35662104 PMCID: PMC9697052 DOI: 10.3233/bmr-210322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Central sensitization (CS) is present in a subgroup of patients with chronic low back pain (CLBP). Studies on the relationship between CS and functioning have limited operationalizations of CS and functioning. OBJECTIVE To determine whether CS was related to functioning in patients with CLBP (cross-sectional); and to determine whether changes in CS were related to changes in functioning (longitudinal). METHODS An observational prospective cohort study with data collected at baseline and discharge of an interdisciplinary pain rehabilitation program was executed. CS indicators: CS Inventory part A (CSI-A), quantitative sensory testing (QST), root mean square of successive differences of heart-rate variability (RMSSD). Functioning measures: lifting capacity, physical functioning subscale of Rand36 (Rand36-PF), Work Ability Score (WAS), Pain Disability Index (PDI). Main analyses included correlation and multiple regression controlling for confounders; cross-sectional with baseline data and longitudinal with deltas (Δ). RESULTS 76 patients with primary CLBP participated at baseline and 56 at discharge. Most associations were weak (cross-sectional r𝑝𝑎𝑟𝑡𝑖𝑎𝑙=-0.30-0.24; longitudinal r𝑝𝑎𝑟𝑡𝑖𝑎𝑙=-0.37-0.44). Cross-sectional multiple regression significant associations: mechanical pain threshold-QST and lifting capacity (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙=-0.39), parasympathetic/vagal tone-RMSSD and physical functioning-Rand36-PF (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙= 0.26). Longitudinal multiple regression significant associations: Δ parasympathetic/vagal tone-RMSSD and Δ lifting capacity (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙= 0.48), ΔCSI-A and Δdisability-PDI (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙= 0.36). Cross-sectional and longitudinal final regression models explained 24.0%-58.3% and 13.3%-38.0% of total variance. CONCLUSION CS was weakly related to functioning, and decreases in CS were weakly-moderately related to increases in functioning.
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Affiliation(s)
- Jone Ansuategui Echeita
- Corresponding author: Jone Ansuategui Echeita, Department of Rehabilitation Medicine, University Medical Center Groningen, P.O. Box 30.002, 9750 RA Haren, The Netherlands. E-mail:
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12
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Carvalho HC, Machado NCSS, Yáñez-Silva A, Rocabado M, Júnior ARDP, Alves LP, Ribeiro W, Lazo-Osório RA. Autonomic nerve regulation in joint hypermobility patients with myofascial trigger points by Musculoskeletal Interfiber Counterirritant Stimulation (MICS). Med Eng Phys 2022; 109:103903. [DOI: 10.1016/j.medengphy.2022.103903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
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Bilika P, Nijs J, Fandridis E, Dimitriadis Z, Strimpakos N, Kapreli E. In the Shoulder or in the Brain? Behavioral, Psychosocial and Cognitive Characteristics of Unilateral Chronic Shoulder Pain with Symptoms of Central Sensitization. Healthcare (Basel) 2022; 10:1658. [PMID: 36141270 PMCID: PMC9498916 DOI: 10.3390/healthcare10091658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the “arm endurance” test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R2 = 0.33), functionality (model 2: p < 0.001, R = 0.50, R2 = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R2 = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R2 = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R2 = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP.
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Affiliation(s)
- Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly, 35100 Lamia, Greece
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1050 Brussels, Belgium
| | - Emmanouil Fandridis
- Hand-Upper Limb-Microsurgery Department, Attika General Hospital KAT, 14561 Kifissia, Greece
| | - Zacharias Dimitriadis
- Health Assessment and Quality of Life Laboratory, Physiotherapy Department, University of Thessaly, 35100 Lamia, Greece
| | - Nikolaos Strimpakos
- Health Assessment and Quality of Life Laboratory, Physiotherapy Department, University of Thessaly, 35100 Lamia, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly, 35100 Lamia, Greece
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Prados G, Miró E, Martínez MP, Sánchez AI, Pichot V, Medina-Casado M, Chouchou F. Effect of Cognitive-Behavioral Therapy on Nocturnal Autonomic Activity in Patients with Fibromyalgia: A Preliminary Study. Brain Sci 2022; 12:brainsci12070947. [PMID: 35884753 PMCID: PMC9320055 DOI: 10.3390/brainsci12070947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: fibromyalgia is a complex chronic pain syndrome characterized by widespread musculoskeletal pain, insomnia and autonomic alterations. Cognitive-behavioral therapy (CBT) is regarded as a promising treatment in fibromyalgia, but its impact on autonomic function remains uncertain. In this research, we studied the effect of CBT on autonomic functions in fibromyalgia. Methods: Twenty-five participants underwent overnight polysomnographic recordings before and after CBT programs focused on pain (CBT-P) or a hybrid modality focused on pain and insomnia (CBT-C). Sleep quality, daily pain, depression and anxiety were assessed by self-reported questionnaires. We analyzed heart rate variability (HRV) using high-frequency power (HF) as a marker for parasympathetic activity, and low-frequency power (LF) and the LF/HF ratio as relative sympathetic markers during wakefulness and at each sleep stage. Results: After treatment, 14 patients (/25, 58.0%) reported improvement in their sleep: 6 in the CBT-P condition (/12, 50%), and 8 in the CBT-C condition (/13, 61.5%). We found that, regardless of the type of CBT, patients who reported improvement in sleep quality (n = 14, 58%) had an increase in HF during stages N2 (p < 0.05) and N3 (p < 0.05). These changes were related to improvement in sleep quality (N2, r = −0.43, p = 0.033) but not to pain, depression or anxiety. Conclusions: This study showed an improvement in parasympathetic cardiac control during non-rapid-eye-movement sleep following CBT in fibromyalgia participants who reported better sleep after this therapy. CBT may have a cardio-protective effect and HRV could be used as a sleep monitoring tool in fibromyalgia.
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Affiliation(s)
- Germán Prados
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Elena Miró
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
- Correspondence: ; Tel.: +34-958249537
| | - M. Pilar Martínez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - Ana I. Sánchez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - Vincent Pichot
- INSERM, U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet, 42023 Saint-Etienne, France;
| | - Marta Medina-Casado
- Blood Transfusion Centre and Tissue Bank of Granada-Almería, 18014 Granada, Spain;
| | - Florian Chouchou
- IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, 97430 Le Tampon, France;
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15
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Park J, Heilman KJ, Sullivan M, Surage J, Levine H, Hung L, Ortega M, Kirk Wiese LA, Ahn H. Remotely supervised home-based online chair yoga intervention for older adults with dementia: Feasibility study. Complement Ther Clin Pract 2022; 48:101617. [PMID: 35738115 DOI: 10.1016/j.ctcp.2022.101617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND and Purpose: Social isolation and caregiver burden call for an innovative way to deliver a chair yoga (CY) intervention to older adults with dementia who cannot travel to a community center. During a remotely supervised CY session, the yoga instructor can monitor each participant's pose and correct poses to optimize efficacy of CY and reduce chances of injury. This study assessed the feasibility of a remotely supervised online CY intervention for older adults with dementia and explored the relationship between CY and clinical outcomes: pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness. METHODS Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to 10 older adults with dementia twice weekly in 60-minute sessions for 8 weeks. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention. RESULTS The results indicated that remotely supervised online CY is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia, based on retention (70%) and adherence (87.5%), with no injury or other adverse events. While there were no significant findings for pain interference, mobility, sleep, or social loneliness longitudinally, emotional loneliness showed a significant increase, F(1.838, 11.029) = 6.293, p = .016, η2 = 0.512, from baseline to post-intervention. Although participants were socially connected to other participants via a videoconferencing platform, emotional loneliness increased during the pandemic period. CONCLUSION A home-based remotely supervised online CY is a feasible approach for socially isolated older adults with dementia who are unable to travel to a facility.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, USA.
| | - Keri J Heilman
- University of North Carolina, Chapel Hill, College of Medicine, Department of Psychiatry, USA
| | - Marlysa Sullivan
- Integrative Health Sciences, Maryland University of Integrative Health, USA
| | - Jayshree Surage
- Integrative Health Sciences, Maryland University of Integrative Health, USA
| | - Hannah Levine
- Charles E. Schmidt College of Medicine, Marcus Institute of Integrative Health at FAU Medicine, Florida Atlantic University, USA
| | - Lillian Hung
- University of British Columbia, School of Nursing, Vancouver, Canada
| | - María Ortega
- Louis and Anne Green Memory and Wellness Center of the Christine E. Lynn College of Nursing, Florida Atlantic University, USA
| | | | - Hyochol Ahn
- Florida State University College of Nursing, Tallahassee, FL, USA
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16
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Galosi E, Truini A, Di Stefano G. A Systematic Review and Meta-Analysis of the Prevalence of Small Fibre Impairment in Patients with Fibromyalgia. Diagnostics (Basel) 2022; 12:diagnostics12051135. [PMID: 35626288 PMCID: PMC9139885 DOI: 10.3390/diagnostics12051135] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 12/30/2022] Open
Abstract
Converging evidence shows that patients with fibromyalgia syndrome have signs of small fibre impairment, possibly leading to pain and autonomic symptoms, with a frequency that has not yet been systematically evaluated. To fill this gap, our review aims to define the frequency of somatic and autonomic small fibre damage in patients with fibromyalgia syndrome, as assessed by objective small fibre-related testing. We found 360 articles on somatic and autonomic small fibre assessment in patients with fibromyalgia. Out of the 88 articles assessed for eligibility, 20 were included in the meta-analysis, involving 903 patients with fibromyalgia. The estimated prevalence of somatic small fibre impairment, as assessed with skin biopsy, corneal confocal microscopy, and microneurography, was 49% (95% confidence interval (CI): 39–60%, I2 = 89%), whereas the estimated prevalence of autonomic small fibre impairment, as assessed with heart rate variability, sympathetic skin response, skin conductance, and tilt testing, was 45% (95% CI: 25–65%, I2 = 91%). Our study shows that a considerable proportion of patients with fibromyalgia have somatic and autonomic small fibre impairment, as assessed by extensive small fibre-related testing. Nevertheless, the heterogeneity and inconsistencies across studies challenge the exact role of small fibre impairment in fibromyalgia symptoms.
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17
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Sochodolak RC, Schamne JC, Ressetti JC, Costa BM, Antunes EL, Okuno NM. A comparative study of heart rate variability and physical fitness in women with moderate and severe fibromyalgia. J Exerc Rehabil 2022; 18:133-140. [PMID: 35582683 PMCID: PMC9081406 DOI: 10.12965/jer.2244070.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to compare the physical fitness and cardiac autonomic activity among women with moderate and severe fibromyalgia (FM) and healthy women. This study included 35 women with FM (age: 46.2±8.9 years) and 17 healthy women (age: 44.3±9.9 years). Participants with FM were divided into moderate FM (n=15) and severe FM (n=20) according to the total score obtained in FM impact questionnaire. The heart rate variability was monitored using a portable cardiac monitor with participants resting in supine position during 10 min. Thereafter, the participants performed the chair sit and reach test, the chair stand test, and the 6-min walk test to measure the lower-body flexibility, lower-body muscle strength, and cardiorespiratory fitness, respectively. The lower-body muscle strength and cardiorespiratory fitness were both reduced in moderate and severe FM compared to healthy women (P<0.01), with greater reduction in severe FM when compared to moderate FM (P<0.05). In addition, the parasympathetic indexes of heart rate variability were all similarly decreased in both moderate and severe FM, when compared to healthy women (P<0.05). The cardiac parasympathetic activity is similarly decreased in women with both moderate and severe FM in comparison to healthy women, despite a greater physical deconditioning in severe FM.
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Affiliation(s)
- Rafael Carlos Sochodolak
- Corresponding author: Rafael Carlos Sochodolak, Department of Physical Education, State University of Ponta Grossa, Ponta Grossa 84030-900, Brazil,
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18
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Model-based assessment of cardiopulmonary autonomic regulation in paced deep breathing. Methods 2022; 204:312-318. [PMID: 35447359 DOI: 10.1016/j.ymeth.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/12/2022] [Accepted: 04/14/2022] [Indexed: 11/21/2022] Open
Abstract
Autonomic dysfunction can lead to many physical and psychological diseases. The assessment of autonomic regulation plays an important role in the prevention, diagnosis, and treatment of these diseases. A physiopathological mathematical model for cardiopulmonary autonomic regulation, namely Respiratory-Autonomic-Sinus (RSA) regulation Model, is proposed in this study. A series of differential equations are used to simulate the whole process of RSA phenomenon. Based on this model, with respiration signal and ECG signal simultaneously acquired in paced deep breathing scenario, we manage to obtain the cardiopulmonary autonomic regulation parameters (CARP), including the sensitivity of respiratory-sympathetic nerves and respiratory-parasympathetic nerves, the time delay of sympathetic, the sensitivity of norepinephrine and acetylcholine receptor, as well as cardiac remodeling factor by optimization algorithm. An experimental study has been conducted in healthy subjects, along with subjects with hypertension and coronary heart disease. CARP obtained in the experiment have shown their clinical significance.
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Martins DF, Viseux FJF, Salm DC, Ribeiro ACA, da Silva HKL, Seim LA, Bittencourt EB, Bianco G, Moré AOO, Reed WR, Mazzardo-Martins L. The role of the vagus nerve in fibromyalgia syndrome. Neurosci Biobehav Rev 2021; 131:1136-1149. [PMID: 34710514 DOI: 10.1016/j.neubiorev.2021.10.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/08/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022]
Abstract
Fibromyalgia (FM) syndrome is a common illness characterized by chronic widespread pain, sleep problems, fatigue, and cognitive difficulties. Dysfunctional neurotransmitter systems that influence the body's endogenous stress response systems are thought to underlie many of the major FM-related symptoms. A model of FM pathogenesis suggests biological and psychosocial variables interact to influence the genetic predisposition, but the precise mechanisms remain unclear. The Polyvagal Theory provides a theoretical framework from which to investigate potential biological mechanisms. The vagus nerve (VN) has anti-inflammatory properties via its afferent and efferent fibers. A low vagal tone (as assessed by low heart rate variability), has been observed in painful and inflammatory diseases, including FM, while the ventral branch of the VN is linked to emotional expression and social engagement. These anti-inflammatory and psychological (limbic system) properties of the VN may possess therapeutic potential in treating FM. This review paper summarizes the scientific literature regarding the potential role of the VN in transducing and/or therapeutically managing FM signs and symptoms.
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Affiliation(s)
- Daniel F Martins
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil.
| | - Frederic J F Viseux
- Laboratoire d'Automatique, de Mécanique et d'Informatique industrielle et Humaine (LAMIH), UMR CNRS 8201, Université Polytechnique des Hauts-de-France, Valenciennes, France; Centre d'Evaluation et de Traitement de la Douleur (CETD), Hôpital Jean Bernard, Centre Hospitalier de Valenciennes, F-59322 Valenciennes, France
| | - Daiana C Salm
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Anny Caroline Avelino Ribeiro
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Helen Kassiana Lopes da Silva
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Lynsey A Seim
- Hospital Internal Medicine, 4500 San Pablo Road, Mayo Clinic, Jacksonville, FL, USA
| | | | - Gianluca Bianco
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, Rome, Italy; Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, Rome, Italy
| | - Ari Ojeda Ocampo Moré
- Integrative Medicine and Acupuncture Service, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - William R Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leidiane Mazzardo-Martins
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Moffet EW, Jones SG, Snyder T, Riedner B, Benca RM, Juergens T. Gulf War veterans exhibit broadband sleep EEG power reductions in regions overlying the frontal lobe. Life Sci 2021; 280:119702. [PMID: 34111462 PMCID: PMC12019881 DOI: 10.1016/j.lfs.2021.119702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022]
Abstract
AIMS Nearly a third of U.S. veterans who deployed in support of the 1990-1991 Persian Gulf War are affected by Gulf War illness (GWI). Here we aimed to characterize whether subjective sleep complaints in GWI veterans are associated with objective sleep EEG disturbances relative to healthy veterans and controls; and whether Gulf War veterans show alterations in neural activity during sleep that differentiate them from healthy subjects. MAIN METHODS We used high-density EEG (HDEEG) to assess regional patterns of rapid eye movement (REM) sleep and non-REM (NREM) sleep between three groups: Gulf War male veterans with fatigue and GWI, Gulf War male veterans without fatigue or GWI, and control males. The groups were matched relative to age, sex and obstructive sleep apnea. Topographic comparisons of nocturnal NREM and REM sleep were made between groups for all frequency bands. KEY FINDINGS Topographic analysis revealed a broadband reduction in EEG power in a circumscribed region overlying the frontal lobe in both groups of Gulf War veterans, regardless of GWI and fatigue. This frontal reduction in neural activity was present, to some extent, across all frequency bands in NREM and REM sleep. SIGNIFICANCE Given that our findings were observed in all Gulf War veterans, it appears unlikely that frontal sleep HDEEG power reductions prove wholly responsible for fatigue symptoms. These results provide avenues for research which may someday contribute to improved clinical care of formerly deployed veterans of the Persian Gulf War.
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Affiliation(s)
- Eric W Moffet
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Stephanie G Jones
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Theodore Snyder
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Ruth M Benca
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States; Department of Psychiatry and Human Behavior, University of California, Irvine, CA, United States
| | - Timothy Juergens
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States; Department of Psychiatry, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
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21
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Martínez OM, Fossion R, Piceno YG, Lopez-Gomez RE, López-Espinosa E, Jiménez-Estrada I, Quiroz-González S. Heart Rate Variability and Psychometric Analysis in Patients with Hyperactive Heart Fire Syndrome. J Acupunct Meridian Stud 2021; 14:137-148. [DOI: 10.51507/j.jams.2021.14.4.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- Oliverio Medina Martínez
- Department of Acupuncture and Rehabilitation, State University of Ecatepec Valley, Ecatepec State of México, Mexico
| | - Ruben Fossion
- Institute for Nuclear Science, National Autonomous University of México, Mexico City, Mexico
- Complexity Science Center (C3), National Autonomous University of México, Mexico City, Mexico
| | - Yolanda García Piceno
- Department of Acupuncture and Rehabilitation, State University of Ecatepec Valley, Ecatepec State of México, Mexico
- Transdiciplinary Health Academic Group (CAST-UNEVE-CA03), Ecatepec State of Mexico, Mexico
| | - Rosa E. Lopez-Gomez
- Department of Acupuncture and Rehabilitation, State University of Ecatepec Valley, Ecatepec State of México, Mexico
- Transdiciplinary Health Academic Group (CAST-UNEVE-CA03), Ecatepec State of Mexico, Mexico
| | - Emma López-Espinosa
- Department of Acupuncture and Rehabilitation, State University of Ecatepec Valley, Ecatepec State of México, Mexico
- Transdiciplinary Health Academic Group (CAST-UNEVE-CA03), Ecatepec State of Mexico, Mexico
| | - Ismael Jiménez-Estrada
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies, National Polytechnic Institute, Mexico City, Mexico
| | - Salvador Quiroz-González
- Department of Acupuncture and Rehabilitation, State University of Ecatepec Valley, Ecatepec State of México, Mexico
- Transdiciplinary Health Academic Group (CAST-UNEVE-CA03), Ecatepec State of Mexico, Mexico
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22
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Electrochemical Skin Conductance Alterations during Spinal Cord Stimulation: An Experimental Study. J Clin Med 2021; 10:jcm10163565. [PMID: 34441864 PMCID: PMC8397194 DOI: 10.3390/jcm10163565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Despite the well-known clinical effects of spinal cord stimulation (SCS), the mechanisms of action have not yet been fully unraveled. The primary aim of this study was to measure whether electrochemical skin conductance, as a measure of peripheral sympathetic autonomic function, is altered by SCS. A second aim was to compare skin conductance levels of patients with failed back surgery syndrome (FBSS) with age- and sex-matched healthy controls. Twenty-three patients with FBSS treated with SCS participated in this study. Sudomotor function was measured with the SudoscanTM instrument on the hands and feet during SCS on and off states. Difference scores in skin conductance between patients and age- and sex-matched healthy controls were calculated. Normal sudomotor function at the painful lower limb was revealed for 61% of the patients when SCS was activated. Skin conductance levels were not altered between on and off states of SCS. Differences in scores between patients and healthy controls were significantly different from zero. This study showed that SCS does not influencing the sympathetic nervous system in patients with FBSS, as measured by skin conductance levels. Moreover, it suggested that there is no normalization of the functioning of the sympathetic nervous system, despite the effectiveness of SCS to reduce pain intensity.
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Veterans' Insights on Heart Rate Variability Biofeedback to Treat Fibromyalgia-Related Pain. Pain Manag Nurs 2021; 23:196-203. [PMID: 34284943 DOI: 10.1016/j.pmn.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart rate variability biofeedback (HRVB) is a self-management strategy that guides individuals to breathe at a designated resonance frequency of the cardiovascular system. Resonant breathing may reduce FM-related symptoms as well as improve physical functioning and quality of life. Although prior research recommends HRVB for chronic pain, we found no studies testing the feasibility for individuals with FM regarding protocol adherence or acceptability of the treatment. AIMS To determine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) protocol in a group of Veterans with fibromyalgia (FM). DESIGN A multi-method feasibility and acceptability study. SETTINGS A Veterans Health outpatient pain medicine clinic. PARTICIPANTS/SUBJECTS We enrolled 7 women and 3 men between the ages of 33 and 68 years with a diagnosis of FM. METHODS We enrolled 10 veterans in a HRVB study using a recommended protocol to treat FM. Veterans were given a HRVB device, emWave2, and instructed to practice at home twice daily for 20 minutes per session. Following a 7-week intervention period, we conducted an end of study focus group. We used content analysis to develop themes to determine the feasibility of engaging in HRVB and adhering to the intervention protocol, as well as insights of veterans about the intervention. RESULTS Three common themes emerged: intervention implementation, protocol adherence, and self-awareness. CONCLUSIONS Results of this study suggest difficulties operating the emWave2 and scheduling challenges interfered with HRVB implementation. However, veterans reported self-awareness of the benefits of HRVB, positive physiological effects, and improved psychological effects. Future studies require a larger sample size to provide a deeper insight.
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24
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The Association Between Heart Rate Variability and Quality of Life in Patients with Functional Somatic Syndrome and Healthy Controls. Appl Psychophysiol Biofeedback 2021; 46:279-285. [PMID: 34132969 DOI: 10.1007/s10484-021-09515-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Functional somatic syndrome (FSS) includes a spectrum of somatic symptoms with insufficient medical explanation. Its underlying pathophysiology is considered to include dysfunctional stress-responsive systems or autonomic dysfunction. Among the autonomic dysfunction readouts, decreased heart rate variability (HRV) has been shown to be characteristic in patients with FSSs. However, its association with quality of life (QOL) has not been clearly examined. We examined the association between short-term resting HRV and QOL in patients with FSS (n = 47) and healthy controls (n = 28). The time domain parameters of HRV were mean heart rate per minute (HR), coefficient of variation of R-R intervals (CvRR) and root mean square of successive differences (RMSSD). The frequency domain parameters of HRV were low-frequency (LF) power and high-frequency (HF) power by power spectrum analysis. The Japanese version of the WHO's QOL scale (WHOQOL-BREF) (WHO/QOL26) was used for the QOL assessment. There was a significant positive association between the RMSSD and HF power of HRV and all the QOL domains in patients with FSSs who had lower QOL scores on average than controls, while there was no association between HRV and any of the QOL domains in the control group. HF power was more dominantly associated with QOL than the other variables in patients with FSS based on the analysis with a multiple linear regression model. The present study elucidated that the HF power of HRV was dominantly associated with QOL in patients with FSSs who had lower QOL than controls. Vagal index of HRV could be a valuable indicator of the pathological condition and a significant predictor of health-related QOL in patients with FSSs.
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25
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Bandeira PM, Reis FJJ, Sequeira VCC, Chaves ACS, Fernandes O, Arruda-Sanchez T. Heart rate variability in patients with low back pain: a systematic review. Scand J Pain 2021; 21:426-433. [PMID: 33930261 DOI: 10.1515/sjpain-2021-0006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Heart rate variability (HRV) is an important physiological measure of the capacity for neurogenic homeostatic regulation, and an indirect measure of emotional processing. We aimed to investigate whether HRV parameters are altered in people with chronic low back pain when compared to healthy controls. METHODS We searched on PubMed, Scopus, CINAHL, Web of Science, Cochrane Library, and PsycINFO from inception to January 2018. The inclusion criteria were: patients with non-specific chronic low back pain, absence of radiculopathy, age from 18 to 65 years, and comparison with healthy controls. Data extraction was performed by two independent review authors. The methodological quality of the studies was assessed using the appraisal tool for cross-sectional studies. RESULTS After screening 2,873 potential articles, two studies met the inclusion criteria. Studies were composed of 153 patients with chronic low back pain and 62 healthy controls. An electrocardiogram was used to record HRV and linear methods (time and frequency) were used to analyze the results. The main findings indicate that patients with chronic low back pain have a significant reduction in HRV, with sympathetic predominance compared to healthy controls. CONCLUSIONS There is limited evidence suggesting that chronic low back pain patients presented a lower vagal activity evidenced by HRV, when compared to healthy controls. The results of this systematic review should be interpreted with caution due to the restricted number of included studies, small sample sizes and different protocols used to measure HRV. The limited evidence about HRV alterations in low back pain also suggests the need of future studies to investigate if HRV parameters can be a useful measure in chronic pain samples or even if it can be used as an outcome in clinical trials aiming to investigate the effectiveness of interventions based on emotion regulation.
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Affiliation(s)
- Pamela M Bandeira
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Felipe J J Reis
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Department of Physical Therapy, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
- Laboratory of Neuroimaging and Psychophysiology, Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vanessa C C Sequeira
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Anna C S Chaves
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Orlando Fernandes
- Laboratory of Neuroimaging and Psychophysiology, Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Postgraduate Program in Radiology, Department of Radiology, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Tiago Arruda-Sanchez
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Neuroimaging and Psychophysiology, Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Department of Radiology, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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AlAujan SS, Almalag HM, Omair MA. Prevalence of Fibromyalgia in Pharmacy Professionals and Students: A Cross-Sectional Study. J Pain Res 2021; 14:837-847. [PMID: 33833561 PMCID: PMC8020587 DOI: 10.2147/jpr.s301916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of fibromyalgia (FM) in pharmacy students and professionals is unknown. This study identifies the prevalence of FM in pharmacy students and professionals using three screening tools and factors associated with its development. Furthermore, this study assesses the level of agreement between the tools and the magnitude of the participants’ responses to each item in the screening tools. Methods This was a cross-sectional survey conducted on members of the Saudi Pharmaceutical Society using an online questionnaire. The participants were asked to fill three questionnaires: the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ), Fibromyalgia Rapid Screening Tool (FiRST) and Fibromyalgia Survey Questionnaire (FSQ). Demographic data and factors affecting FM in pharmacy students and professionals were collected and analysed. Results Two hundred ninety-three participants accessed the survey: most of them were Saudi (93.5%) and females (78.8%) with a mean (standard deviation) age of 29 (8) years. Furthermore, 52% of the participants had generalised body pain. The prevalence of FM using FiRST, LFESSQ Pain, LFESSQ with fatigue criteria and FSQ was 27.1%, 34.9%, 50.9% and 68.4%, respectively. Fleiss’ kappa coefficient revealed fair agreement among all three screening tools (kappa = 0.350; p < 0.001). After adjusting for significant variables, the resulting adjusted odds ratio of developing FM was 4.86 in people working for 41–45 h weekly (95% confidence interval [CI], 1.32–17.84; p = 0.017), 5.16 in people who frequently wake up during sleep (95% CI, 1.85–14.40; p = 0.002) and 12.99 in people with sleep apnea or other sleeping disorders (95% CI, 2.07–81.68; p = 0.006). Conclusion FM was prevalent among pharmacy students and professionals and was much more than data reported on the general population or other healthcare workers. Traditional factors along with higher working hours were identified as significant variables.
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Affiliation(s)
- Shiekha S AlAujan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Haya M Almalag
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Omair
- Division of Rheumatology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
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Riquelme I, do Rosário RS, Vehmaskoski K, Natunen P, Montoya P. Autonomous nervous system regulation of pain in children with cerebral palsy. Brain Inj 2021; 35:356-362. [PMID: 33682539 DOI: 10.1080/02699052.2020.1863469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aim: Children with cerebral palsy (CP) have increased pain sensitivity and recurrent pain episodes; however, pain is underreported in children with intellectual impairment. Cardiac autonomic regulation is imbalanced in chronic pain conditions and neurological disorders. This study aims at exploring the autonomous nervous system regulation of pain in children with CP compared with typically developing peers (TDP).Method: Heart rate variability (HRV) was recorded during 24 hours in 26 children with CP and 26 TDP, and examined offline at baseline (sleeping, seated rest) and during spontaneous pain events. Pain and fatigue, HRV indices (linear indices on time - IBI, SDNN, RMSSD - and frequency domains - high, low, and very low frequency - and non-linear indices - Hurst coefficient and multiscale entropy) were computed.Results: Children with CP showed comparable HRV during daily conditions and similar reductions after pain events than their TDP, regardless of their level of intellectual impairment. Interpretation: Children with CP have an intact autonomic regulation in acute pain events. HRV could be an accurate pain biomarker in children with CP and intellectual disability.What this paper adds: Autonomic regulation in acute pain is efficient in children with cerebral palsy.Heart rate variability indices can be reliable pain biomarkers in intellectual impairment.
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Affiliation(s)
- Inmaculada Riquelme
- University Institute of Health Sciences Research (Iunics-idispa), University of the Balearic Islands, Palma De Mallorca, Spain.,Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma De Mallorca, Spain
| | | | - Kari Vehmaskoski
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Pekka Natunen
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Pedro Montoya
- University Institute of Health Sciences Research (Iunics-idispa), University of the Balearic Islands, Palma De Mallorca, Spain
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Reyes Del Paso GA, Contreras-Merino AM, de la Coba P, Duschek S. The cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia: Associations with pain, affective impairments, sleep problems, and fatigue. Psychophysiology 2021; 58:e13800. [PMID: 33645659 DOI: 10.1111/psyp.13800] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 12/22/2022]
Abstract
This study investigated the cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia using the spontaneous sequence method. Systolic blood pressure (SBP), interbeat interval (IBI), stroke volume (SV), pre-ejection period (PEP), and total peripheral resistance (TPR) were continuously recorded in 40 fibromyalgia patients and 30 healthy individuals during a cold pressor test and a mental arithmetic task. Sequences of covariation between SBP and IBI (cardiac branch), SV and PEP (myocardial branch), and TPR (vasomotor branch) were identified. Baroreflex sensitivity (BRS) was represented by the slope of the regression line between values in the sequences; baroreflex effectiveness (BEI) was indexed by the proportion of progressive SBP changes that elicited reflex responses. Patients exhibited lower BRS in the three branches, lower BEI in the cardiac and vasomotor branches, and reduced reactivity in cardiac BRS and BEI, SBP, IBI, SV, and PEP. Moreover, BRS and BEI were inversely related to clinical pain, cold pressor pain, depression, trait anxiety, sleep problems, and fatigue. Reduced function of the three baroreflex branches implies diminished resources for autonomic inotropic, chronotropic, and vascular regulation in fibromyalgia. Blunted stress reactivity indicates a limited capacity for autonomic cardiovascular adjustment to situational requirements. The associations of BRS and BEI with pain perception may reflect the antinociceptive effects arising from baroreceptor afferents, where reduced baroreflex function may contribute to the hyperalgesia characterizing fibromyalgia. The associations with affective impairments, sleep problems, and fatigue suggest that baroreflex dysfunctions are also involved in the secondary symptoms of the disorder.
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Affiliation(s)
| | | | | | - Stefan Duschek
- Institute of Psychology, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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29
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Reduced Heart Rate Variability in Patients With Medically Unexplained Physical Symptoms: A Meta-Analysis of HF-HRV and RMSSD. Psychosom Med 2021; 83:2-15. [PMID: 33065584 DOI: 10.1097/psy.0000000000000874] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Medically unexplained physical symptoms (MUPS) and related syndromes are common and place a substantial burden on both patients and society. Chronic psychological distress and dysregulation of the autonomic nervous system may be common factors associated with MUPS, although previous studies have reported mixed results. The aims of this meta-analysis are to provide an updated synthesis of studies investigating heart rate variability (HRV) indices associated with autonomic nervous system functioning in three common MUPS syndromes and to explain inconsistencies in previous study findings. METHODS Literature search yielded 58 studies comparing HRV indices of reduced parasympathetic activity of healthy individuals with those of patients with chronic fatigue syndrome (npatients = 271), irritable bowel syndrome (npatients = 1005), and fibromyalgia (npatients = 534). Separate random-effects meta-analyses were conducted on studies measuring root mean square of successive differences (RMSSD) and high-frequency HRV (HF-HRV). RESULTS Regardless of syndrome type, patients had significantly lower RMSSD (k = 22, Hedges g = -0.37 [-0.53 to -0.21], p < .001) and HF-HRV (k = 52, Hedges g = -0.69 [-1.03 to -0.36], p < .001) than did healthy individuals. Sample age and publication year explained a substantial variation in RMSSD, whereas controlling for confounders in statistical analyses explained variation in HF-HRV. CONCLUSIONS Lower RMSSD and HF-HRV in patients with MUPS versus healthy controls indicates that autonomic nervous system dysregulation, particularly lower parasympathetic activity, may play a role in patients with these conditions. This conclusion may have important implications for the underlying mechanisms and treatment of MUPS and related syndromes.
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Reneau M. Feasibility and Acceptability of Heart Rate Variability Biofeedback in a Group of Veterans with Fibromyalgia. J Altern Complement Med 2020; 26:1025-1031. [DOI: 10.1089/acm.2020.0071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Marcelaine Reneau
- Integrative Pain Clinic, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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31
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Hazra S, Venkataraman S, Handa G, Yadav SL, Wadhwa S, Singh U, Kochhar KP, Deepak KK, Sarkar K. A Cross-Sectional Study on Central Sensitization and Autonomic Changes in Fibromyalgia. Front Neurosci 2020; 14:788. [PMID: 32848561 PMCID: PMC7417433 DOI: 10.3389/fnins.2020.00788] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
Fibromyalgia is a multi-symptomatic disorder characterized by generalized pain. The pathophysiology of fibromyalgia is supposedly an interplay between central nervous system hyper-responsiveness, autonomic dysfunction, and peripheral pain. In this cross-sectional study, the objective was to assess central sensitization and autonomic activity in patients with fibromyalgia compared with control. Fifty adults diagnosed with fibromyalgia by the modified American College of Rheumatology 2010 criteria and an equal number of age- and sex-matched controls participated in the study in an urban tertiary care hospital. Central sensitization was assessed by history and by evidence of increased prefrontal cortical activity as measured by cortical oxygenation using functional near-infrared spectroscopy. Autonomic activity was assessed by heart rate variability, electrodermal activity, and deep breathing test in three physiological states: rest, sympathetic stress (cold pressor test), and deep breathing. Mann–Whitney U-test, paired t-test, Wilcoxon test, and Friedman test with Bonferroni a priori were used to analyze the data. Cortical activity was significantly higher in the fibromyalgia group than control. There was no significant difference in autonomic activity between the fibromyalgia and control groups. In the fibromyalgia group, variable degrees of sympathetic hyperactivity and normal parasympathetic activity were observed. Central sensitization may be playing a primary role in the pathophysiology of generalized pain in fibromyalgia.
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Affiliation(s)
- Sandipan Hazra
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Gita Handa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - S L Yadav
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Wadhwa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - U Singh
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - K P Kochhar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - K K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kaushik Sarkar
- Department of Electronics and Communication Engineering, Narula Institute of Technology, Kolkata, India
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Aksu E, Berk E, Sökmen A, Sökmen G, Çelik E. Subclinical cardiac structural and electrical abnormalities in fibromyalgia syndrome. Turk J Med Sci 2020; 50:885-893. [PMID: 32283905 PMCID: PMC7379451 DOI: 10.3906/sag-1912-228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/11/2020] [Indexed: 12/19/2022] Open
Abstract
Background/aim In the literature, there is a paucity of data about the effects of fibromyalgia syndrome (FMS) on myocardial function and electrophysiological properties of atrium and ventricles. In this study, we investigated cardiac functions and noninvasive predictors of arrhythmias in patients with FMS. Materials and methods The study included 43 female patients diagnosed with FMS and 30 age- and sex-matched healthy subjects. The presence of fragmented QRS (fQRS) morphology, P dispersion, QT dispersion, inter- and intraatrial electromechanical delay was evaluated in the groups with 12-lead ECG and standard and tissue Doppler echocardiography. Results Among electrocardiographic parameters, P dispersion, QT dispersion, and the ratio of presence of fQRS morphology were found to be significantly higher in the study group as compared to the control group. In lateral and septal, the ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em) was significantly higher in the study group. Additionally, intra- and interatrial electromechanical delay was found significantly prolonged in the study group. Conclusion FMS is found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients.
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Affiliation(s)
- Ekrem Aksu
- Department of Cardiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ejder Berk
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Abdullah Sökmen
- Department of Cardiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Gülizar Sökmen
- Department of Cardiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Enes Çelik
- Department of Cardiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Ansuategui Echeita J, Schiphorst Preuper HR, Dekker R, Stuive I, Timmerman H, Wolff AP, Reneman MF. Central Sensitisation and functioning in patients with chronic low back pain: protocol for a cross-sectional and cohort study. BMJ Open 2020; 10:e031592. [PMID: 32152155 PMCID: PMC7064083 DOI: 10.1136/bmjopen-2019-031592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION A relevant subsample of patients with chronic low back pain (CLBP) have manifested augmented central pain processing, central sensitisation (CS). Patients with CLBP have limited functioning and participation. Theoretically, physical functioning in patients with CLBP can plausibly be linked to CS; however, evidence to explain such association is scarce. Moreover, there is no gold standard for CS diagnosis. The objectives of the study are: (1) to analyse the association between instruments assessing reference symptoms and signs attributed to CS; (2) to analyse whether reference symptoms and signs attributed to CS are associated with functioning measurement outcomes; and (3) to analyse whether changes (between baseline and discharge) in reference symptoms and signs attributed to CS are related to changes in each of the functioning measurement outcomes. METHODS AND ANALYSIS A cross-sectional and longitudinal observational study is performed with measurements taken at baseline and discharge of an interdisciplinary rehabilitation programme. A sample size of 110 adult patients with CLBP has been calculated for the study. CS measurements are: Central Sensitisation Inventory, quantitative sensory testing and heart rate variability. Functioning measurements are: lifting capacity, maximal aerobic capacity, accelerometry and reported functioning. Statistical analyses to be performed are: (1) correlation between CS measurements, (2) multiple regression between functioning (dependent variable) and CS measurements (independent variable), and (3) multiple regression between changes in scores of functioning (dependent variable) and CS measurements (independent variable), and corrected for sex and age. ETHICS AND DISSEMINATION The study obtained the clearance to its implementation from the Medical Research Ethics Committee of the University Medical Center Groningen in July 2017. The results will be disseminated through scientific publications in peer-reviewed journals, presentations at relevant conferences, and reports to stakeholders. TRIAL REGISTRATION NUMBER NTR7167/NL6980.
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Affiliation(s)
- Jone Ansuategui Echeita
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henrica R Schiphorst Preuper
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilse Stuive
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans Timmerman
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andre P Wolff
- Department of Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Naranjo-Hernández D, Reina-Tosina J, Roa LM. Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E365. [PMID: 31936420 PMCID: PMC7014460 DOI: 10.3390/s20020365] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/15/2022]
Abstract
Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.
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Affiliation(s)
- David Naranjo-Hernández
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
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Reneau M. Heart Rate Variability Biofeedback to Treat Fibromyalgia: An Integrative Literature Review. Pain Manag Nurs 2019; 21:225-232. [PMID: 31501080 DOI: 10.1016/j.pmn.2019.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 06/14/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Fibromyalgia (FM) is associated with debilitating pain and a reduced heart rate variability (HRV), reflecting decreased emotional adaptability and resistance to stress. Common pharmacological treatments are ineffective, and opioids are highly addictive and cause an estimated 15,000 overdose deaths per year. Effective recommendations include patient-centered interventions like physical activity, cognitive behavioral therapy, and biofeedback. Heart rate variability biofeedback (HRVB) may be effective in improving HRV, thus increasing stress resistance and emotional adaptability and reducing pain. DESIGN This integrative literature review was conducted to examine the relationship between HRVB and FM-related chronic pain using the Theory of Symptom Self-Management and to identify available HRVB technology. DATA SOURCES We searched PubMed, EBSCOhost, and Google Scholar electronic databases for relevant publications. Manuscripts were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses strategy, and study quality was assessed using the Critical Appraisal Skills Programme guidelines. The relationship between HRVB and FM was analyzed and evaluated based on the methodological framework proposed by Whittemore and Knafl. REVIEW/ANALYSIS METHODS We reviewed 22 articles and included six in this review. Five reported HRVB as a treatment for chronic pain, and one for FM pain. RESULTS Overall, the articles in this review support the claim that HRVB is related to decreased pain. The researchers evaluated five HRVB programs, three on handheld devices and two on desktop computers. CONCLUSIONS The reviewed studies had methodological flaws. However, HRVB is a promising treatment for chronic pain. Larger, randomized controlled studies are needed to thoroughly evaluate the relationship between HRVB and FM pain.
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Affiliation(s)
- Marcelaine Reneau
- Department of Anesthesia, Pain Clinic, Veterans' Health Administration, Charleston, South Carolina.
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Adler-Neal AL, Waugh CE, Garland EL, Shaltout HA, Diz DI, Zeidan F. The Role of Heart Rate Variability in Mindfulness-Based Pain Relief. THE JOURNAL OF PAIN 2019; 21:306-323. [PMID: 31377215 DOI: 10.1016/j.jpain.2019.07.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/24/2019] [Accepted: 07/27/2019] [Indexed: 12/30/2022]
Abstract
Mindfulness meditation is a self-regulatory practice premised on sustaining nonreactive awareness of arising sensory events that reliably reduces pain. Yet, the specific analgesic mechanisms supporting mindfulness have not been comprehensively disentangled from the potential nonspecific factors supporting this technique. Increased parasympathetic nervous system (PNS) activity is associated with pain relief corresponding to a number of cognitive manipulations. However, the relationship between the PNS and mindfulness-based pain attenuation remains unknown. The primary objective of the present study was to determine the role of high-frequency heart rate variability (HF HRV), a marker of PNS activity, during mindfulness-based pain relief as compared to a validated, sham-mindfulness meditation technique that served as a breathing-based control. Sixty-two healthy volunteers (31 females; 31 males) were randomized to a 4-session (25 min/session) mindfulness or sham-mindfulness training regimen. Before and after each group's respective training, participants were administered noxious (49°C) and innocuous (35°C) heat to the right calf. HF HRV and respiration rate were recorded during thermal stimulation and pain intensity and unpleasantness ratings were collected after each stimulation series. The primary analysis revealed that during mindfulness meditation, higher HF HRV was more strongly associated with lower pain unpleasantness ratings when compared to sham-mindfulness meditation (B = -.82, P = .04). This finding is in line with the prediction that mindfulness-based meditation engages distinct mechanisms from sham-mindfulness meditation to reduce pain. However, the same prediction was not confirmed for pain intensity ratings (B = -.41). Secondary analyses determined that mindfulness and sham-mindfulness meditation similarly reduced pain ratings, decreased respiration rate, and increased HF HRV (between group ps < .05). More mechanistic work is needed to reliably determine the role of parasympathetic activation in mindfulness-based pain relief as compared to other meditative techniques. Perspective: Mindfulness has been shown to engage multiple mechanisms to reduce pain. The present study extends on this work to show that higher HRV is associated with mindfulness-induced reductions in pain unpleasantness, but not pain intensity ratings, when compared to sham-mindfulness meditation. These findings warrant further investigation into the mechanisms engaged by mindfulness as compared to placebo.
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Affiliation(s)
- Adrienne L Adler-Neal
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christian E Waugh
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
| | - Eric L Garland
- College of Social Work & Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, Utah
| | - Hossam A Shaltout
- Department of Surgery/Hypertension and Vascular Research, Cardiovascular Sciences Center, Winston-Salem, North Carolina; Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Debra I Diz
- Department of Surgery/Hypertension and Vascular Research, Cardiovascular Sciences Center, Winston-Salem, North Carolina
| | - Fadel Zeidan
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Anesthesiology, University of California San Diego, San Diego, California.
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Karri J, Li S, Chen YT, Stampas A, Li S. Observations of Autonomic Variability Following Central Neuromodulation for Chronic Neuropathic Pain in Spinal Cord Injury. Neuromodulation 2019; 24:427-433. [PMID: 31199549 DOI: 10.1111/ner.12979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/31/2019] [Accepted: 05/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) persons with chronic neuropathic pain (NP) demonstrate maladaptive autonomic profiles compared to SCI counterparts without NP (SCI - NP) or able-bodied (AB) controls. These aberrations may be secondary to maladaptive neuroplasticity in the shared circuitry of the pain neuromatrix-central autonomic network interface (PNM-CAN). In this study, we explored the proposed PNM-CAN mechanism in SCI + NP and AB cohorts following centrally-directed neuromodulation to assess if the PNM and CAN are capable of being differentially modulated. MATERIALS AND METHODS Central neuromodulation was administered via breathing-controlled electrical stimulation (BreEStim), previously evidenced to operate at the PNM. To quantify CAN activity, conventional heart rate variability (HRV) recordings were used to gather time and frequency domain parameters of autonomic modulation. SCI + NP (n = 10) and AB (n = 13) cohorts received null and active BreEStim randomly in crossover fashion. HRV data were gathered pretest and 30 minutes posttest. Pain modulation was quantified at both time-points by visual analog scale (VAS) for SCI + NP persons and electrical detection and pain threshold levels (EDT, EPT) for AB persons. RESULTS Following active BreEStim only, SCI + NP persons demonstrated increased parasympathetic tone (increased NN50, p = 0.03, and pNN50, p = 0.02, HRV parameters). This parasympathetic restoration was associated with analgesia (VAS reduction, p < 0.01). Similarly, AB persons demonstrated increased noxious tolerance (increased EPT, p = 0.03, with preserved EDL, p = 0.78) only following active BreEStim. However, this increased pain threshold was not associated with autonomic changes. CONCLUSIONS Central modulation targeting the PNM produced autonomic changes in SCI + NP persons but not AB persons. These findings suggest that AB persons exhibit intact CAN mechanisms capable of compensating for PNM aberrations or simply that SCI + NP persons exhibit altered PNM-CAN machinery altogether. Our collective findings confirm the interconnectedness and maladaptive plasticity of PNM-CAN machinery in SCI + NP persons and suggest that the PNM and CAN circuitry can be differentially modulated.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.,TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Shengai Li
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yen-Ting Chen
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Argyrios Stampas
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sheng Li
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
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Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT Diagnostic Criteria for Fibromyalgia. THE JOURNAL OF PAIN 2019; 20:611-628. [PMID: 30453109 DOI: 10.1016/j.jpain.2018.10.008] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
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Drury RL, Simonetti SA. Heart Rate Variability in Dental Science. Front Med (Lausanne) 2019; 6:13. [PMID: 30788344 PMCID: PMC6372525 DOI: 10.3389/fmed.2019.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/16/2019] [Indexed: 11/13/2022] Open
Abstract
Dentistry has made progress as a profession by integration with both medicine and other human sciences, especially when it uses empirical metrics to study process and outcome variables. Notably, progress in our understanding of genomic, biomic, and other molecular biological phenomena has been valuable. As has been identified by Drury (1, 2), it is proposed in this commentary that the inclusion of heart rate variability (HRV) as a biomarker of health may further this integrative progress. HRV is derived by various linear and non-linear statistical analyses of the R-R, beat-to-beat ECG interval in microseconds. Over twenty three thousand reports are identified in a recent PubMed search of the term heart rate variability, most of which demonstrate HRV's sensitivity to a wide diversity of physical and psychosocial pathologies. The small literature of dental use of HRV in both assessment and treatment will be selectively reviewed and relevant exemplars for other important health applications of HRV will be discussed. This will lead to a proposed agenda for researching HRV's value to professional dentistry as a human health and wellness profession.
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Affiliation(s)
- Robert L Drury
- ReThink Health, Bainbridge Island, WA, United States.,Institute for Discovery, University of Wisconsin, Madison, WI, United States
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Dyball D, Evans S, Boos CJ, Stevelink SAM, Fear NT. The association between PTSD and cardiovascular disease and its risk factors in male veterans of the Iraq/Afghanistan conflicts: a systematic review. Int Rev Psychiatry 2019; 31:34-48. [PMID: 31041877 DOI: 10.1080/09540261.2019.1580686] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Military personnel with Post-Traumatic Stress Disorder (PTSD) can experience high levels of mental and physical health comorbidity, potentially indicating a high level of functional impairment that can impact on both military readiness and later ill-health. There is strong evidence to implicate PTSD as a contributory factor to Cardiovascular Disease (CVD) among serving personnel and veterans. This systematic review focusses on the association between PTSD and cardiovascular disease/risk factors in male, military serving and ex-serving personnel who served in the Iraq/Afghanistan conflicts. PUBMED, MEDLINE, PILOTS, EMBASE, PSYCINFO, and PSYCARTICLES were searched using PRISMA guidelines. Three hundred and forty-three records were identified, of which 20 articles were selected. PTSD was positively associated with the development of CVD, specifically circulatory diseases, including hypertension. PTSD was also positively associated with the following risk factors: elevated heart rate, tobacco use, dyslipidaemia, and obesity. Conflicting data is presented regarding heart rate variability and inflammatory markers. Future studies would benefit from a standardized methodological approach to investigating PTSD and physical health manifestations. It is suggested that clinicians offer health advice for CVD at an earlier age for ex-/serving personnel with PTSD.
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Affiliation(s)
- Daniel Dyball
- a King's Centre for Military Health Research, Psychological Medicine , King's College London , London , UK.,b ADVANCE study, Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre Stanford Hall , Loughborough , UK
| | - Sarah Evans
- a King's Centre for Military Health Research, Psychological Medicine , King's College London , London , UK.,b ADVANCE study, Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre Stanford Hall , Loughborough , UK
| | - Christopher J Boos
- b ADVANCE study, Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre Stanford Hall , Loughborough , UK.,c Department of Postgraduate Medical Education , Bournemouth University , Poole , UK
| | - Sharon A M Stevelink
- a King's Centre for Military Health Research, Psychological Medicine , King's College London , London , UK.,d Department of Psychological Medicine , King's College London , London , UK
| | - Nicola T Fear
- a King's Centre for Military Health Research, Psychological Medicine , King's College London , London , UK.,b ADVANCE study, Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre Stanford Hall , Loughborough , UK.,e Academic Department for Military Mental Health , King's College London , London , UK
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Le Fur Bonnabesse A, Cabon M, L’Heveder G, Kermarrec A, Quinio B, Woda A, Marchand S, Dubois A, Giroux-Metges MA, Rannou F, Misery L, Bodéré C. Impact of a specific training programme on the neuromodulation of pain in female patient with fibromyalgia (DouFiSport): a 24-month, controlled, randomised, double-blind protocol. BMJ Open 2019; 9:e023742. [PMID: 30782715 PMCID: PMC6352822 DOI: 10.1136/bmjopen-2018-023742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The main symptom of fibromyalgia (FM) is diffuse pain. There is currently no aetiological treatment for FM. However, all pain associations and best practice guidelines strongly advocate the practice of aerobic physical activity to improve the symptoms of FM subjects. The mechanisms of dysfunctional pain are mostly central and related to stress axis dysfunction (autonomic nervous system and corticotropic axis). Our main objective is to assess the efficacy of a specific training programme on endogenous pain control mechanisms in female patients with FM. Further aims include rebalancing the autonomic neurovegetative system, improving quality of life and sleep quality, and reintegrating patients into society and work. METHODS AND ANALYSIS 110 female patients with FM diagnosed on American College of Rheumatology 2010 criteria, aged 18-65 years and meeting inclusion conditions will be recruited and randomised into two groups (active and semiactive). The training programme will consist of three 45 min sessions per week of supervised, individualised physical activity over 2 years. Only the intensity of the exercises will differ between the two groups (moderate intensity vs low intensity).All outcome measures will be conducted at baseline (T0), after 6-9 months of training (T6-9) and after 24 months of training (T24). The primary endpoint will be an improvement of pain modulation (activation of diffuse noxious inhibitory control) evaluated by the stimulation test. The secondary endpoint will be relief of pain, anxiety, depression, stress, sleep disorders, pain impact on life quality, and improved heart rate, blood pressure and salivary cortisol. ETHICS AND DISSEMINATION This study is approved by the Committee for the Protection of Persons West VI. The results will be published in specialised scientific journals and will be presented at scientific meetings on pain and/or physical activity. TRIAL REGISTRATION NUMBER NCT02486965; Pre-results.
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Affiliation(s)
- Anais Le Fur Bonnabesse
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
- Dental Faculty, University of Western Brittany (UBO), Brest, France
| | - Mathilde Cabon
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
| | - Gildas L’Heveder
- Neurological Functional Explorations, University Hospital of Brest, Brest, France
| | - Aurélie Kermarrec
- Physiotherapy Training Institute, University Hospital of Brest, Brest, France
| | - Bertrand Quinio
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
| | - Alain Woda
- Odontology Department, University Clermont Auvergne, CROC and Teaching Hospital EA3847, Clermont-Ferrand, France
| | - Serge Marchand
- Department of Surgery, Universite de Sherbrooke Faculte de Medecine et des Sciences de la Sante, Sherbrooke, Quebec, Canada
| | - Amandine Dubois
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Cognition, Behaviour, Communication (LP3C), EA1285, Laboratoire de Psychologie, Rennes, France
- Département de Psychologie, University of Western Brittany (UBO), Brest, France
| | - Marie-Agnes Giroux-Metges
- ORPHY EA4324, Optimisation of Physiological Regulations, EA4324, Faculty of Medicine and Health Sciences, University of Western Brittany (UBO), Brest, France
- Respiratory Functional Exploration Unit, University Hospital of Brest, Brest, France
| | - Fabrice Rannou
- ORPHY EA4324, Optimisation of Physiological Regulations, EA4324, Faculty of Medicine and Health Sciences, University of Western Brittany (UBO), Brest, France
- Respiratory Functional Exploration Unit, University Hospital of Brest, Brest, France
| | - Laurent Misery
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
| | - Céline Bodéré
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
- Dental Faculty, University of Western Brittany (UBO), Brest, France
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Lee C, Liptan G, Kantorovich S, Sharma M, Brenton A. Association of Catechol- O-methyltransferase single nucleotide polymorphisms, ethnicity, and sex in a large cohort of fibromyalgia patients. BMC Rheumatol 2018; 2:38. [PMID: 30886988 PMCID: PMC6390547 DOI: 10.1186/s41927-018-0045-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/09/2018] [Indexed: 12/16/2022] Open
Abstract
Background Fibromyalgia (FM) is a complex, centralized pain condition that is often difficult to diagnose and treat. FM is considered to have a genetic background due to its familial aggregation and due to findings from multiple candidate-gene studies implicating catecholaminergic and serotonergic neurotransmitter systems in chronic pain. However, a multi-factorial analysis of both genetic and environmental risk factors is lacking. A better characterization of the interplay of risk factors may assist in understanding the pathophysiology of FM, its clinical course, and assist in early diagnosis and treatment of the disorder. Methods This retrospective study included 60,367 total participants from 237 clinics across the USA. Of those, 2713 had been diagnosed with fibromyalgia, as indicated by ICD code. Logistic regression was used to test for associations of diagnosed FM in study subjects with COMT SNPs and COMT haplotypes, which were previously found to be linked with pain sensitivity, as well as demographics such as age, sex, and ethnicity. The minor allele frequencies of COMT SNPs in the FM population were compared with 1000 Genomes data using a χ2 test to determine significant deviations from the estimated population allelic frequencies. Results FM diagnosis was strongly associated with sex, age, and ethnicity. Females, those between 49 and 63 years, and non-Caucasians were at higher risk of FM. Females had 1.72 increased odds of FM (p = 1.17 × 10− 30). African-Americans were 1.52 times more likely to have a diagnosis of FM compared to Caucasians (p = 3.11 × 10− 12). Hispanics were less likely to have a diagnosis of FM compared to Caucasians (p = 3.95 × 10− 7). After adjusting for sex and ethnicity, those in the low age group and mid age group had 1.29 (p = 1.02 × 10− 5) and 1.60 (p = 1.93 × 10− 18) increased odds of FM, respectively, compared to the high age group, where age was categorized by tertile (low (< 49), mid (49–63), and high (> 63)). The COMT haplotypes associated with pain sensitivity were not associated with FM, but African-Americans were 11.3 times more likely to have a high pain sensitivity COMT diplotype, regardless of FM diagnosis. However, the minor alleles of COMT SNPs rs4680, rs4818, rs4633 and rs6269 were overrepresented in the FM population overall, and varied when compared with ethnically-similar populations from 1000 Genomes. Conclusions This is the largest study, to date, that examines demographic and genetic associations of FM in a diverse population. While pain sensitivity-associated COMT haplotypes were not found to be directly associated with FM diagnosis, the minor alleles that make up the COMT haplotypes were overrepresented in the FM population, suggesting a role of COMT in FM. Future studies are needed to elucidate the exact role of COMT variation in widespread pain conditions, such as FM. Clinically, this information can be used to provide insight into the pathways underlying FM and to identify those at greater risk of developing FM. Electronic supplementary material The online version of this article (10.1186/s41927-018-0045-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chee Lee
- Proove Biosciences, Inc., Irvine, CA USA
| | | | | | | | - Ashley Brenton
- Mycroft Bioanalytics, Inc., 299 South Main Street, Suite 2300, Salt Lake City, UT 84111-2278 USA
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Sadeghi R, Banerjee T, Romine W. Early Hospital Mortality Prediction using Vital Signals. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2018; 9-10:265-274. [PMID: 30873427 PMCID: PMC6411064 DOI: 10.1016/j.smhl.2018.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Early hospital mortality prediction is critical as intensivists strive to make efficient medical decisions about the severely ill patients staying in intensive care units (ICUs). As a result, various methods have been developed to address this problem based on clinical records. However, some of the laboratory test results are time-consuming and need to be processed. In this paper, we propose a novel method to predict mortality using features extracted from the heart signals of patients within the first hour of ICU admission. In order to predict the risk, quantitative features have been computed based on the heart rate signals of ICU patients suffering cardiovascular diseases. Each signal is described in terms of 12 statistical and signal-based features. The extracted features are fed into eight classifiers: decision tree, linear discriminant, logistic regression, support vector machine (SVM), random forest, boosted trees, Gaussian SVM, and K-nearest neighborhood (K-NN). To derive insight into the performance of the proposed method, several experiments have been conducted using the well-known clinical dataset named Medical Information Mart for Intensive Care III (MIMIC-III). The experimental results demonstrate the capability of the proposed method in terms of precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). The decision tree classifier satisfies both accuracy and interpretability better than the other classifiers, producing an F1-score and AUC equal to 0.91 and 0.93, respectively. It indicates that heart rate signals can be used for predicting mortality in patients in the care units especially coronary care units (CCUs), achieving a comparable performance with existing predictions that rely on high dimensional features from clinical records which need to be processed and may contain missing information.
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Affiliation(s)
- Reza Sadeghi
- Department of Computer Science and Engineering, Kno.e.sis Research Center, Wright State University, Dayton, OH, USA
| | - Tanvi Banerjee
- Department of Computer Science and Engineering, Kno.e.sis Research Center, Wright State University, Dayton, OH, USA
| | - William Romine
- Department of Biological Sciences, Wright State University, Dayton, OH, USA
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Badry R, Gamal RM, Hassanien MM, El Hamed MA, Hammam N, El Fawal BM. Sympathetic skin response in patients with systemic sclerosis and rheumatoid arthritis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:38. [PMID: 30546249 PMCID: PMC6267634 DOI: 10.1186/s41983-018-0044-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/18/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Sympathetic skin response (SSR) is a technique to assess the sympathetic cholinergic pathways. Sympathetic dysfunction may participate in the development of pain, which is the major complaint in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). OBJECTIVES In this study, we aimed to assess the autonomic dysfunction in patients with (SSc) and (RA) using SSR as a simple neurophysiologic test. METHODS Palmar SSR to median nerve electrical stimulation was recorded in 21 patients with SSc, 39 patients with RA, and in 60 healthy age and sex-matched control subjects. RESULTS Palmar SSR to median nerve stimulation (of SSc patients and RA patients) shows significantly delayed latency and reduced amplitude in comparison to the control group. SSR of SSc patients has significantly delayed latency and reduced amplitude when compared to RA patients. Moreover, six SSc patients have delayed SSR in spite of the absence of manifestations of polyneuropathy. CONCLUSIONS Patients with SSc and RA have features of autonomic dysfunction with more affection of SSc patients.
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Affiliation(s)
- Reda Badry
- Department of Neurology and Psychiatry, Assiut University Hospital, Post Box: 711526, Assiut, Egypt
| | - Rania M. Gamal
- Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt
| | - Manal M. Hassanien
- Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt
| | - Mohamed Abd El Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Post Box: 711526, Assiut, Egypt
| | - Nevin Hammam
- Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt
| | - Bastawy M. El Fawal
- Department of Neurology and Psychiatry, Aswan University Hospital, Aswan, Egypt
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The association between fibromyalgia and female sexual dysfunction: a systematic review and meta-analysis of observational studies. Int J Impot Res 2018; 31:288-297. [PMID: 30467351 DOI: 10.1038/s41443-018-0098-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/29/2018] [Accepted: 10/26/2018] [Indexed: 01/11/2023]
Abstract
Female sexuality in patients with fibromyalgia has received little attention in the literature, and published data have mainly relied upon a small sample size with evident heterogeneity. Our aim was to pool the observational studies on the association between fibromyalgia and sexual dysfunction in female patients to reach a more comprehensive and reliable result. The literature search comprised of Pubmed-Medline, Cochrane, and Embase databases. The relevant studies that met the inclusion criteria were gathered and the pooled effect size was calculated. The standard mean difference of the global sexual function score as well as the sub-items scores were calculated using the random-effect size model. Sensitivity analysis was conducted. Publication bias was assessed using Funnel plots and Begg and Mazumdar rank correlation tests. The meta-analysis was conducted in accordance with the MOOSE guideline. The six selected studies contained 919 participants (ranging from 51 to 362). Of those, 578 were patients with fibromyalgia, and 341 were the controls. While four studies evaluated the sexual function using the female sexual function index (FSFI) questionnaire, two used changes in the sexual functioning questionnaire (CSFQ). Patients with fibromyalgia had a decreased total sexual function score [(-5.02 (-7.58 to -2.46), p < 0.0001; Q = 664.28; p-value for heterogeneity = p < 0.0001; I2 = 99.24%)]. All sexual response cycle domains including desire, arousal, orgasm, pain, lubrication, and satisfaction were found detrimental in patients with fibromyalgia compared with the healthy controls. For the sensitivity analysis, omitting any one of the six studies did not produce a significant difference in the original pooled summary effect size. Our meta-analysis provided a clear association between female sexual dysfunction and fibromyalgia, suggesting patients with fibromyalgia should be assessed regarding sexual health, although further, well designed longitudinal studies are needed to establish the causality between fibromyalgia and female sexual dysfunction.
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Karri J, Li S, Zhang L, Chen YT, Stampas A, Li S. Neuropathic pain modulation after spinal cord injury by breathing-controlled electrical stimulation (BreEStim) is associated with restoration of autonomic dysfunction. J Pain Res 2018; 11:2331-2341. [PMID: 30349358 PMCID: PMC6190809 DOI: 10.2147/jpr.s174475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recent findings have implicated supraspinal origins from the pain neuromatrix- central autonomic network (PNM-CAN) in the generation of neuropathic pain (NP) after spinal cord injury (SCI). The aim of this study was to further investigate the theorized PNM-CAN mechanisms in persons with SCI by using a centrally directed pain intervention, provided by breathing-controlled electrical stimulation (BreEStim), to measure resultant autonomic changes measured by time and frequency domain heart rate variability (HRV) analysis. METHODS Null and active BreEStim interventions were administered to SCI+NP subjects (n=10) in a random order. HRV data and VAS pain scores were collected at resting pre-test and 30 minutes post-test time points. Resting HRV data were also collected from SCI-NP subjects (n=11). RESULTS SCI+NP subjects demonstrated a lower baseline HRV and parasympathetic tone, via SD of the normal-to-normal intervals (SDNN) and low frequency (LF) parameters, compared with SCI-NP subjects. However, following active BreEStim, SCI+NP subjects exhibited an increase in HRV and parasympathetic tone, most notably via pairs of successive R-R beat lengths varying by greater than 50 ms (NN50) and proportion of NN50 for total number of beats (pNN50) parameters along with lower VAS scores. Additionally, the post-test SCI+NP group was found to have a statistically comparable autonomic profile to the SCI-NP group across all HRV variables, including SDNN and LF parameters. CONCLUSION The analgesic effects of active BreEStim in SCI+NP subjects were associated with restoration of autonomic dysfunction in this population.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,
| | - Shengai Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,
| | - Larry Zhang
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,
| | - Yen-Ting Chen
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
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Montoro CI, Duschek S, Schuepbach D, Gandarillas M, Reyes del Paso GA. Cerebral blood flow variability in fibromyalgia syndrome: Relationships with emotional, clinical and functional variables. PLoS One 2018; 13:e0204267. [PMID: 30235315 PMCID: PMC6147545 DOI: 10.1371/journal.pone.0204267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/04/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study analyzed variability in cerebral blood flow velocity (CBFV) and its association with emotional, clinical and functional variables and medication use in fibromyalgia syndrome (FMS). METHODS Using transcranial Doppler sonography, CBFV were bilaterally recorded in the anterior (ACA) and middle (MCA) cerebral arteries of 44 FMS patients and 31 healthy individuals during a 5-min resting period. Participants also completed questionnaires assessing pain, fatigue, insomnia, anxiety, depression and health-related quality of life (HRQoL). RESULTS Fast Fourier transformation revealed a spectral profile with four components: (1) a first very low frequency (VLF) component with the highest amplitude at 0.0024 Hz; (2) a second VLF component around 0.01-to-0.025 Hz; (3) a low frequency (LF) component from 0.075-to-0.11 Hz; and (4) a high frequency (HF) component with the lowest amplitude from 0.25-to-0.35 Hz. Compared to controls, FMS patients exhibited lower LF and HF CBFV variability in the MCAs (p < .005) and right ACA (p = .03), but higher variability at the first right MCA (p = .04) and left ACA (p = .005) VLF components. Emotional, clinical and functional variables were inversely related to LF and HF CBFV variability (r≥-.24, p≤.05). However, associations for the first VLF component were positive (r≥.28, p≤.05). While patients´ medication use was associated with lower CBFV variability, comorbid depression and anxiety disorders were unrelated to variability. CONCLUSIONS Lower CBFV variability in the LF and HF ranges were observed in FMS, suggesting impaired coordination of cerebral regulatory systems. CBFV variability was differentially associated with clinical variables as a function of time-scale, with short-term variability being related to better clinical outcomes. CBFV variability analysis may be a promising tool to characterize FMS pathology and it impact on facets of HRQoL.
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Affiliation(s)
| | - Stefan Duschek
- UMIT—University for Health Sciences Medical Informatics and Technology, Hall in Tirol, Austria
| | - Daniel Schuepbach
- Klinikum am Weissenhof, Zentrum für Psychiatrie Weinsberg, Weinsberg, Germany
- University of Heidelberg, Department of General Psychiatry, Center of Psychosocial Medicine, Heidelberg, Germany
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Affiliation(s)
- Steven E. Harte
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Richard E. Harris
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Daniel J. Clauw
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
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Medial prefrontal cortex TRPV1 and CB1 receptors modulate cardiac baroreflex activity by regulating the NMDA receptor/nitric oxide pathway. Pflugers Arch 2018; 470:1521-1542. [PMID: 29845313 DOI: 10.1007/s00424-018-2149-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/10/2018] [Accepted: 04/27/2018] [Indexed: 12/23/2022]
Abstract
The ventral medial prefrontal cortex (vMPFC) facilitates the cardiac baroreflex response through N-methyl-D-aspartate (NMDA) receptor activation and nitric oxide (NO) formation by neuronal NO synthase (nNOS) and soluble guanylate cyclase (sGC) triggering. Glutamatergic transmission is modulated by the cannabinoid receptor type 1 (CB1) and transient receptor potential vanilloid type 1 (TRPV1) receptors, which may inhibit or stimulate glutamate release in the brain, respectively. Interestingly, vMPFC CB1 receptors decrease cardiac baroreflex responses, while TRPV1 channels facilitate them. Therefore, the hypothesis of the present study is that the vMPFC NMDA/NO pathway is regulated by both CB1 and TRPV1 receptors in the modulation of cardiac baroreflex activity. In order to test this assumption, we used male Wistar rats that had stainless steel guide cannulae bilaterally implanted in the vMPFC. Subsequently, a catheter was inserted into the femoral artery, for cardiovascular recordings, and into the femoral vein for assessing baroreflex activation. The increase in tachycardic and bradycardic responses observed after the microinjection of a CB1 receptors antagonist into the vMPFC was prevented by an NMDA antagonist as well as by the nNOS and sGC inhibition. NO extracellular scavenging also abolished these responses. These same pharmacological manipulations inhibited cardiac reflex enhancement induced by TRPV1 agonist injection into the area. Based on these results, we conclude that vMPFC CB1 and TRPV1 receptors inhibit or facilitate the cardiac baroreflex activity by stimulating or blocking the NMDA activation and NO synthesis.
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Walker LS, Stone AL, Smith CA, Bruehl S, Garber J, Puzanovova M, Diedrich A. Interacting influences of gender and chronic pain status on parasympathetically mediated heart rate variability in adolescents and young adults. Pain 2018; 158:1509-1516. [PMID: 28715351 DOI: 10.1097/j.pain.0000000000000942] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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.
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Affiliation(s)
- Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Amanda L Stone
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Craig A Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Martina Puzanovova
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - André Diedrich
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, USA
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