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Autonomic reactivity in muscle pain: clinical and experimental assessment
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There are numerous indications of possible involvement of the autonomic nervous system in the genesis of chronic pain. The possibility exists that sympathetic activation is related to motor dysfunction and changes in sensory processing, which have otherwise been implicated in musculoskeletal disorders.

The primary aim of the thesis has been to investigate autonomic regulation at rest and in response to laboratory tests of autonomic function in subjects suffering from chronic pain in different localisations (lower back, neck-shoulder and neck-jaw), as well as to study the relations between autonomic regulation, proprioceptive acuity and clinical data. Secondary aim has been to assess autonomic regulation in fit, pain-free subjects in response to experimentally induced pain and in occupationally relevant settings.

A total of 194 subjects suffering from chronic pain participated [low back pain (LBP) n=93; non-traumatic neck pain (NT) n=40, Whiplash associated disorder (WAD) n=40, Whiplash with temporomandibular dysfunction (WADj) n=21]. Each chronic pain group was subjected to a battery of autonomic function tests combining cognitive (Stroop Colour-Word conflict tests), physical (handgrip), sensory (unpleasant sound) and motor tasks (chewing tests) as well as the activation of reflex pathways (paced breathing and the orthostatic test) and compared to an age- and gender balanced control group. Autonomic regulation was also assessed in exposure to experimentally induced muscle pain in healthy subjects (n=24) in order to describe acute pain reaction. Further assessment was carried out during monotonous repetitive work and dynamic work in healthy subjects (n=10) and in a three-day monitoring of ambulance personnel (n=26) in occupational settings.

Autonomic regulation was evaluated using cardiovascular (heart rate and heart rate variability, local blood flow and blood pressure), respiratory (breathing rate) electrodermal (skin conductance), muscular (trapezius and masseter EMG) and biochemical (insulin, cortisol, catecholamines) variables. Proprioceptive acuity was assessed using active-active repositioning tests. Pain levels were assessed using Visual-analogue or Numerical Rating scales. General health was evaluated through the Short-Form SF-36 Health Related Quality of Life questionnaire and Self-Efficacy Score questionnaires, whereas dysfunction was evaluated using the Oswestry Low Back Pain questionnaire, Pain Disability and Neck Disability Index questionnaires, the McKenzie evaluation and primary healthcare diagnoses. Self-reports of pain, stress and exertion were acquired prior to, during and post-testing.

Chronic pain subjects were characterised by increased sympathetic and decreased parasympathetic activity as reflected in heart rate (LBP, WAD, WADj), heart rate variability (LBP, WAD, WADj), blood pressure (WADj) and electrodermal activity (LBP). In general, WAD showed more pain and dysfunction than NT, with lower self-efficacy and health-related quality of life. Differential reactivity was observed only in WAD, with increased responsiveness to sensory stimuli (heart rate variability, electrodermal activity), and motor tasks (heart rate) and a decreased response to cognitive challenge (heart rate variability, electrodermal activity). A significant part of WADj subjects showed sensorimotor impairment and low endurance in chewing tests, concomitant with a cardiovascular response that correlated with pain levels. Proprioceptive acuity was not found to be impaired among subjects suffering from chronic pain, and there were no indications of significant individual response specificity. Response to experimentally induced muscle pain in healthy subjects was also characterised by a prominent cardiovascular component. In simulated occupational settings autonomic activation and transient insulin resistance were detected in healthy subjects following monotonous repetitive work, with no similar effects following dynamic exercise. Modest deviations in circadian heart rate variability patterns during workdays were detected in ambulance personnel reporting more pronounced musculoskeletal symptoms, with no such effects on work-free days.

Autonomic balance observed in chronic pain subjects was characterised by a trend towards increased sympathetic activity in comparison with pain-free controls. Moderate signs of affected reactivity to autonomic function tests were observed in patients with WAD, however no specific reaction patterns have been observed in any chronic pain group. Correspondence between the intensity of pain and autonomic activity was observed in acute pain and in chronic pain groups characterised by higher pain levels. As indicated by autonomic and neurohormonal changes in the recovery from real and simulated work, further studies with physiological monitoring of the effects of work-related stress are warranted for better understanding of the mechanism of musculoskeletal disorders.

Place, publisher, year, edition, pages
Umeå: Kirurgisk och perioperativ vetenskap , 2006. , 62 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1061
Keyword [en]
autonomic reactivity, stress, chronic pain, experimental pain, back, shoulder, neck
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-919ISBN: 91-7264-144-4 (print)OAI: oai:DiVA.org:umu-919DiVA: diva2:145048
Public defence
2006-11-30, Stora föreläsningssalen, Arbetslivsinstutet, Johan Bures väg 5, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2006-11-09 Created: 2006-11-09 Last updated: 2009-10-09Bibliographically approved
List of papers
1. Physiological reactivity to functional tests in patients with chronic low back pain
Open this publication in new window or tab >>Physiological reactivity to functional tests in patients with chronic low back pain
2007 (English)In: Journal of Musculoskeletal Pain, ISSN 1058-2452, E-ISSN 1540-7012, Vol. 15, no 1, 29-40 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of the present study was to investigate autonomic regulation at rest and in response to functional laboratory tests in patients with chronic low back pain [CLBP], as well as its possible relations to different characteristics of the clinical picture.

Methods: Ninety-three CLBP patients [47 females, 45 males; age 38 +/- 7 years] and 32 healthy normal control subjects [15 females, 16 males: 36 +/- 9 years] participated. Subjects were examined according to the McKenzie procedure, and filled in Short Form 36 and Oswestry Disability Questionnaires in addition to self-reports of pain. An electrocardiogram, finger plethysmogram, respiration, and skin conductance were recorded. Functional tests included the Stroop Color-Word test, orthostatic test, paced breathing, and handgrip. A five-minute baseline recording was followed by four counterbalanced functional tests, separated by two- to three-minute long pauses.

Results: An analysis of variance revealed higher baseline heart rate [P=0.011 in females only], low frequency spectral power [P=0.001] and electrodermal activity [P=0.048], and lower high frequency spectral power [P=0.001]. Each functional test evoked a response, without any group differences in physiological reactivity. There were no significant differences with respect to physiological reactivity between subgroups formed on the basis of prior diagnoses, McKenzie evaluation, VAS pain estimates, Short Form 36, and Oswestry Disability Questionnaire data. The patients did not show high levels of individual response specificity.

Conclusions: Presented data show that patients with CLBP exhibit increased sympathetic tonus in comparison with the control group, regardless of CLBP patients' level of pain, functional disability, or clinical status indices.

Place, publisher, year, edition, pages
Binghamton: Haworth Press, 2007
Keyword
Chronic low back pain, functional tests, stress, stressors, physiological reactivity
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-5508 (URN)10.1300/J094v15n01_05 (DOI)000245695200006 ()
External cooperation:
Available from: 2006-11-09 Created: 2006-11-09 Last updated: 2017-12-14Bibliographically approved
2. Autonomic responsiveness, shoulder proprioception and clinical symptoms in subjects with whiplash-associated disorder and non-traumatic chronic pain in the neck-shoulder region
Open this publication in new window or tab >>Autonomic responsiveness, shoulder proprioception and clinical symptoms in subjects with whiplash-associated disorder and non-traumatic chronic pain in the neck-shoulder region
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Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-5509 (URN)
Available from: 2006-11-09 Created: 2006-11-09 Last updated: 2010-01-13Bibliographically approved
3. Physiological reactivity to a functional chewing test in whiplash associated disorder patients and controls
Open this publication in new window or tab >>Physiological reactivity to a functional chewing test in whiplash associated disorder patients and controls
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Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-5510 (URN)
Available from: 2006-11-09 Created: 2006-11-09 Last updated: 2010-01-13Bibliographically approved
4. Low frequency therapeutic EMF differently influences experimental muscle pain in female and male subjects
Open this publication in new window or tab >>Low frequency therapeutic EMF differently influences experimental muscle pain in female and male subjects
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2005 (English)In: Bioelectromagnetics, ISSN 0197-8462, E-ISSN 1521-186X, Vol. 26, no 4, 299-304 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-5511 (URN)10.1002/bem.20092 (DOI)15832331 (PubMedID)
Available from: 2006-11-09 Created: 2006-11-09 Last updated: 2017-12-14Bibliographically approved
5. Short-term effects of repetitive arm work and dynamic exercise on glucose metabolism and insulin sensitivity.
Open this publication in new window or tab >>Short-term effects of repetitive arm work and dynamic exercise on glucose metabolism and insulin sensitivity.
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2005 (English)In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 183, no 4, 345-356 p.Article in journal (Refereed) Published
Keyword
Adult, Arm, Blood Glucose/analysis, Blood Pressure/physiology, Epinephrine/blood, Ergometry/methods, Exercise/*physiology, Fatty Acids; Nonesterified/blood, Glucose/*metabolism, Heart Rate/physiology, Humans, Hydrocortisone/blood, Insulin/blood/*metabolism, Insulin Resistance/physiology, Interleukin-6/blood, Lactates/blood, Leptin/blood, Male, Muscle Contraction/physiology, Muscle; Skeletal/*physiology, Norepinephrine/blood, Tumor Necrosis Factor-alpha/analysis
Identifiers
urn:nbn:se:umu:diva-13371 (URN)doi:10.1111/j.1365-201X.2005.01407.x (DOI)15799771 (PubMedID)
Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2017-12-14Bibliographically approved
6. Stress monitoring of ambulance personnel during work and leisure time.
Open this publication in new window or tab >>Stress monitoring of ambulance personnel during work and leisure time.
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2006 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 80, no 1, 51-59 p.Article in journal (Refereed) Published
Keyword
Adult, Ambulances/*manpower, Blood Pressure/physiology, Cross-Sectional Studies, Emergency Medical Technicians/*psychology, Energy Metabolism/physiology, Female, Heart Rate/physiology, Humans, Hydrocortisone/analysis, Leisure Activities, Male, Medical Records, Monitoring; Physiologic, Occupational Diseases/*diagnosis/epidemiology/psychology, Personnel Staffing and Scheduling, Questionnaires, Stress/*diagnosis/epidemiology, Stress; Psychological/*diagnosis/epidemiology, Time Factors, Work Schedule Tolerance
Identifiers
urn:nbn:se:umu:diva-6064 (URN)10.1007/s00420-006-0103-x (DOI)16680487 (PubMedID)
Available from: 2007-12-05 Created: 2007-12-05 Last updated: 2017-12-14Bibliographically approved

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