(337) 24-hour high-frequency heart rate variability in chronic pain patients compared to healthy controls – A meta-analysis

Background: A large body of scientific literature derived from experimental studies emphasizes the vital role of vagal-nociceptive networks in acute pain processing. However, research on vagal activity, indexed by vagally-mediated heart rate variability (vmHRV) in chronic pain patients (CPPs), has not yet been summarized. Objectives: To systematically investigate differences in vagus nerve activity indexed by timeand frequency-domain measures of vmHRV in CPPs compared to healthy controls (HCs). Study Design: A systematic review and meta-analysis, including meta-regression on a variety of populations (i.e., clinical etiology) and study-level (i.e., length of HRV recording) covariates. Setting: Not applicable (variety of studies included in the meta-analysis) Methods: Eight computerized databases (PubMed via MEDLINE, PsycNET, PsycINFO, Embase, CINAHL, Web of Science, PSYNDEX, and the Cochrane Library) in addition to a hand search were systematically screened for eligible studies based on pre-defined inclusion criteria. A metaanalysis on all empirical investigations reporting short- and long-term recordings of continuous time- (root-mean-square of successive R-R-interval differences [RMSSD]) and frequency-domain measures (high-frequency [HF] HRV) of vmHRV in CPPs and HCs was performed. True effect estimates as adjusted standardized mean differences (SMD; Hedges g) combined with inverse variance weights using a random effects model were computed. Results: CPPs show lower vmHRV than HCs indexed by RMSSD (Z = 5.47, P < .0001; g = -0.24;95% CI [-0.33, -0.16]; k = 25) and HF (Z = 4.54, P < .0001; g = -0.30; 95% CI [-0.44, -0.17]; k = 61).Meta-regression on covariates revealed significant differences by clinical etiology, age, gender, and length of HRV recording. Limitations: We did not control for other potential covariates (i.e., duration of chronic pain, medication intake) which may carry potential risk of bias. Conclusion(s): The present meta-analysis is the most extensive review of the current evidence on vagal activity indexed by vmHRV in CPPs. CPPs were shown to have lower vagal activity, indexed by vmHRV, compared to HCs. Several covariates in this relationship have been identified. Further research is needed to investigate vagal activity in CPPs, in particular prospective and longitudinal follow-up studies are encouraged. Key words: Vagus nerve, heart rate variability, chronic pain, irritable bowel syndrome, fibromyalgia, primary headache disorders, meta-analysis, systematic review

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Resting vagal activity in schizophrenia: Meta-analysis of heart rate variability as a potential endophenotype

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.160762 ◽

2016 ◽

Vol 208 (1) ◽

pp. 9-16 ◽

Cited By ~ 59

Author(s):

Annika Clamor ◽

Tania M. Lincoln ◽

Julian F. Thayer ◽

Julian Koenig

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

High Frequency ◽

Meta Analysis ◽

Random Effect ◽

Vagal Tone ◽

Sensitivity Analyses ◽

Psychotic Symptoms ◽

Vagal Activity ◽

Healthy Controls

BackgroundCardiac vagal tone, indexed by heart rate variability (HRV), is a proxy for the functional integrity of feedback mechanisms integrating central and peripheral physiology.AimsTo quantify differences in HRV in individuals with schizophrenia compared with healthy controls.MethodDatabases were systematically searched for studies eligible for inclusion. Random effect meta-analyses of standardised mean differences were calculated for vagal activity indicated by high-frequency HRV and the root mean square of successive R–R interval differences (RMSSD).ResultsThirty-four studies were included. Significant main effects were found for high-frequency HRV (P = 0.0008; Hedges' g =–0.98, 95% CI −1.56 to −0.41, k = 29) and RMSSD (P<0.0001; g =–0.91, 95% CI −1.19 to −0.62, k = 24), indicating lower vagal activity in individuals with schizophrenia than in healthy controls. Considerable heterogeneity was evident but effects were robust in subsequent sensitivity analyses.ConclusionsGiven the association between low HRV, threat processing, emotion regulation and executive functioning, reduced vagal tone may be an endophenotype for the development of psychotic symptoms.

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Heart rate variability in chronic pain patients: a study on gender differences

International Journal of Pharma and Bio Sciences ◽

10.22376/ijpbs.2017.8.2.b463-469 ◽

2017 ◽

Vol 8 (2) ◽

Author(s):

SANJEEV K. SINGH ◽

ATANU ROY ◽

AK TIW ARI ◽

PB SINGH

Keyword(s):

Gender Differences ◽

Heart Rate ◽

Chronic Pain ◽

Heart Rate Variability ◽

Chronic Pain Patients ◽

Pain Patients

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679 Prevalence of Sleep Disturbances in Patients with Chronic Non-cancer Pain: A Systematic Review and Meta-Analysis

SLEEP ◽

10.1093/sleep/zsab072.677 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A265-A266

Author(s):

Yishi Sun ◽

Isabelle Laksono ◽

Janannii Selvanathan ◽

Aparna Saripella ◽

Mahesh Nagappa ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Sleep Quality ◽

Cancer Pain ◽

Sleep Disturbances ◽

Meta Analysis ◽

Pain Group ◽

Pooled Prevalence ◽

Chronic Pain Patients ◽

Pain Patients

Abstract Introduction In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Methods Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. Chronic pain was defined as pain >3 months. Comorbid sleep disorders such as sleep disordered breathing and restless leg syndrome were excluded. Sleep disturbances were defined using the PSQI cutoff of > 5 (poor sleep quality) and ISI ≥ 8 (subthreshold to clinical insomnia). The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores. Results The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3,597 chronic pain patients (mean age 53 ± 12 years; 74% female). In eight studies using ISI, the pooled prevalence was 72.9% among 2,578 chronic pain patients (mean age 63 ± 12 years; 57% female). The meta-analysis showed a significant mean difference of 2.75 (p < 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The meta-analysis also showed a significant mean difference in the scores of four of seven PSQI components: sleep latency, sleep efficiency, sleep duration, and sleep disturbances (p < 0.05). Conclusion In chronic pain patients, the pooled prevalence of sleep disturbances as measured by PSQI (75.3%) and ISI (72.9%) studies was much higher than those reported for the general population. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain. Support (if any):

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Effect of Acupuncture on Heart Rate Variability: A Systematic Review

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/819871 ◽

2014 ◽

Vol 2014 ◽

pp. 1-19 ◽

Cited By ~ 22

Author(s):

Joanne W. Y. Chung ◽

Vincent C. M. Yan ◽

Hongwei Zhang

Keyword(s):

Systematic Review ◽

Heart Rate ◽

Heart Rate Variability ◽

High Frequency ◽

Healthy Subjects ◽

Keyword Search ◽

Data Extraction ◽

Meta Analysis ◽

Low Frequency ◽

Control Group

Aim.To summarize all relevant trials and critically evaluate the effect of acupuncture on heart rate variability (HRV).Method.This was a systematic review with meta-analysis. Keyword search was conducted in 7 databases for randomized controlled trials (RCTs). Data extraction and risk of bias were done.Results.Fourteen included studies showed a decreasing effect of acupuncture on low frequency (LF) and low frequency to high frequency ratio (LF/HF ratio) of HRV for nonhealthy subjects and on normalized low frequency (LF norm) for healthy subjects. The overall effect was in favour of the sham/control group for high frequency (HF) in nonhealthy subjects and for normalized high frequency (HF norm) in healthy subjects. Significant decreasing effect on HF and LF/HF ratio of HRV when acupuncture was performed on ST36 among healthy subjects and PC6 among both healthy and nonhealthy subjects, respectively.Discussion.This study partially supports the possible effect of acupuncture in modulating the LF of HRV in both healthy and nonhealthy subjects, while previous review reported that acupuncture did not have any convincing effect on HRV in healthy subjects. More published work is needed in this area to determine if HRV can be an indicator of the therapeutic effect of acupuncture.

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Effectiveness of Acceptance and Commitment Therapy for Chronic Pain Patients: A Systematic Review and Meta-Analysis

Journal of Korean Academy of Psychiatric and Mental Health Nursing ◽

10.12934/jkpmhn.2019.28.3.271 ◽

2019 ◽

Vol 28 (3) ◽

pp. 271

Author(s):

Hee-Sook Kang ◽

Sung-Dong Hwang ◽

Sang-Eun Jun

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Acceptance And Commitment Therapy ◽

Meta Analysis ◽

Commitment Therapy ◽

Acceptance And Commitment ◽

Chronic Pain Patients ◽

Pain Patients

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Electroencephalography During Nociceptive Stimulation in Chronic Pain Patients: A Systematic Review

Pain Medicine ◽

10.1093/pm/pnaa131 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3413-3427

Author(s):

Dorine Lenoir ◽

Ward Willaert ◽

Iris Coppieters ◽

Anneleen Malfliet ◽

Kelly Ickmans ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Neuropathic Pain ◽

Subjective Experience ◽

Event Related Potential ◽

High Temporal Resolution ◽

Healthy Controls ◽

Somatosensory Processing ◽

Chronic Pain Patients ◽

Pain Patients

Abstract Background With its high temporal resolution, electroencephalography (EEG), a technique that records electrical activity of cortical neuronal cells, is a potentially suitable technique to investigate human somatosensory processing. By using EEG, the processing of (nociceptive) stimuli can be investigated, along with the functionality of the nociceptive pathway. Therefore, it can be applied in chronic pain patients to objectify whether changes have occurred in nociceptive processing. Typically, so-called event-related potential (ERP) recordings are used, where EEG signals are recorded in response to specific stimuli and characterized by latency and amplitude. Objective To summarize whether differences in somatosensory processing occur between chronic pain patients and healthy controls, measured with ERPs, and determine whether this response is related to the subjective pain intensity. Design Systematic review. Setting and Methods PubMed, Web of Science, and Embase were consulted, and 18 case–control studies were finally included. Subjects The chronic pain patients suffered from tension-type headache, back pain, migraine, fibromyalgia, carpal tunnel syndrome, prostatitis, or complex regional pain syndrome. Results Chronic neuropathic pain patients showed increased latencies of the N2 and P2 components, along with a decreased amplitude of the N2-P2 complex, which was also obtained in FM patients with small fiber dysfunction. The latter also showed a decreased amplitude of the N2-P3 and N1-P1 complex. For the other chronic pain patients, the latencies and the amplitudes of the ERP components did not seem to differ from healthy controls. One paper indicated that the N2-P3 peak-to-peak amplitude correlates with the subjective experience of the stimulus. Conclusions Differences in ERPs with healthy controls can mostly be found in chronic pain populations that suffer from neuropathic pain or where fiber dysfunction is present. In chronic pain populations with other etiological mechanisms, limited differences were found or agreed upon across studies.

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