Background: Patients with chronic musculoskeletal pain have a higher chance of presenting
impairment in cardiovascular autonomic modulation, which may have implications for
cardiovascular events. The autonomic nervous system plays an important role in pain modulation.
However, it is unclear whether patients with inefficient descending nociceptive inhibition have
poorer cardiovascular autonomic modulation.
Objective: To compare the cardiovascular autonomic modulation of patients with musculoskeletal
pain who had normal versus impaired functioning of descending nociceptive inhibitory system
(DNIS).
Study Design: A cross-sectional study.
Setting: Physiotherapy outpatient service.
Methods: Fifty-six patients with musculoskeletal pain were included. Conditioned pain
modulation was assessed by the difference of algometric values held in the dorsal forearm and
tibialis anterior muscle, before and after a thermal pain stimulus was employed via the cold pressure
test (CPT). Patients with inefficient DNIS in both sites were classified as impaired responders (n =
14). The others were classified as normal responders (n = 42). Cardiac autonomic modulation was
monitored at rest by heart rate variability (HRV). The blood pressure response to the CPT was used
as a proxy of sympathetic responsiveness.
Results: Most of the patients were women (60%) and had chronic pain (75%). The groups had
similar demographic characteristics. Patients with impaired DNIS showed lower HRV [RMSSD (P =
0.020), SDRR (P = 0.009), HF (ms2
) (P = 0.027), LF (ms2
) (P = 0.004), and total power (P = 0.002)].
The blood pressure response to CPT was similar between groups (systolic pressure, P = 0.813;
diastolic pressure, P = 0.709).
Limitation: Physical activity level, emotional changes, and visceral pathologies can alter the
autonomic nervous system and may represent potential confounders. The low number of patients
may have biased the results.
Conclusion: Patients with impaired DNIS presented lower resting HRV, indicating an altered vagal
control of the heart. In contrast, the blood pressure response to a sympathoexcitatory stimulus was
preserved.
The study was approved by the Research Ethics Committee of Augusto Motta University Centre
(CAAE number: 46245215.9.0000.5235), and all patients signed the Informed Consent Form.
Key words: Musculoskeletal pain, autonomic nervous system, heart rate, chronic pain, diffuse
noxious inhibitory control, blood pressure, sympathetic nervous system, parasympathetic nervous
system
Patients with Impaired Descending Nociceptive
Inhibitory System Present Altered Cardiac
Vagal Control at Rest
