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Autonomic nervous system regulation in chronic neck-shoulder pain: Relations to physical activity and perceived stress
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Neck-shoulder pain (NSP) is a highly prevalent musculoskeletal disorder with unclear causes, and effective prevention and treatment require a further understanding of the underlying mechanisms. Aberrant autonomic nervous system (ANS) regulation is a hypothesized causal element in the development and maintenance of chronic muscle pain.

The overall aim of this thesis was to investigate possible differences in ANS regulation between chronic NSP and healthy control (CON) groups using both laboratory assessment and ambulatory monitoring in daily life.

Four papers are included in this thesis, based on data from three groups with chronic NSP. Autonomic responses to laboratory stressors were assessed using heart rate variability (HRV), blood pressure, trapezius muscle activity and blood flow measurements (Study І) in NSP and CON. Long-term ambulatory monitoring of HRV, physical activity and perceived symptoms were assessed in Studies ІІ and IV to investigate group differences in real-life conditions. Finally, the effects of a ten-week intervention (using individually adjusted HRV biofeedback) to reinstating ANS balance in subjects with chronic NSP were evaluated using self-reported symptoms and health ratings, as well as autonomic regulation testing (i.e., evaluating HRV at rest and in response to stress) (Study ІІІ).

The main findings from the four studies demonstrated aberrant ANS regulation in the NSP group compared to CON, which was predominantly characterized by diminished parasympathetic cardiac activity during rest and sleep, and altered sympathetic reactivity to laboratory stressors (Studies І, ІІ and IV). Different patterns in physical activity were observed between the NSP and CON groups, with reduced physical activity during leisure time in the NSP group (Studies ІІ and IV). Physical activity was found to be positively associated with HRV. Positive effects of HRV-biofeedback were found on perceived health, including social function, vitality and bodily pain, and improved HRV (Study ІІІ).

In conclusion, imbalanced ANS regulation was demonstrated among persons with chronic NSP at both the systemic and local levels. Diminished parasympathetic activity in NSP was modulated by lower levels of physical activity in leisure time. Interventions targeting ANS functions might benefit persons with chronic NSP.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 68 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 851
Keyword [en]
Autonomic imbalance, Daily physical activity, Trapezius myalgia, Treatment, Parasympathetic, Sympathetic
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-187613ISBN: 978-91-554-8561-0 (print)OAI: oai:DiVA.org:uu-187613DiVA: diva2:575861
Public defence
2013-02-08, Hus 33, Sal 202, Högskolan i Gävle, Kungsbäcksvägen 47, Gävle, 10:00 (English)
Opponent
Supervisors
Available from: 2013-01-18 Created: 2012-12-10 Last updated: 2013-02-11Bibliographically approved
List of papers
1. Effects of static contraction and cold stimulation on cardiovascular autonomic indices, trapezius blood flow and muscle activity in chronic neck-shoulder pain
Open this publication in new window or tab >>Effects of static contraction and cold stimulation on cardiovascular autonomic indices, trapezius blood flow and muscle activity in chronic neck-shoulder pain
2011 (English)In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 111, no 8, 1725-1735 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to investigate reactions in trapezius muscle blood flow (MBF), muscle activity, heart rate variability (HRV) and systemic blood pressure (BP) to autonomic tests in subjects with chronic neck-shoulder pain and healthy controls. Changes in muscle activity and blood flow due to stress and unfavourable muscle loads are known underlying factors of work-related muscle pain. Aberration of the autonomic nervous system (ANS) is considered a possible mechanism. In the present study, participants (n = 23 Pain, n = 22 Control) performed autonomic tests which included a resting condition, static hand grip test (HGT) at 30% of maximal voluntary contraction, a cold pressor test (CPT) and a deep breathing test (DBT). HRV was analysed in time and frequency domains. MBF and muscle activity were recorded from the upper trapezius muscles using photoplethysmography and electromyography (EMG). The pain group showed reduced low frequency-HRV (LF) and SDNN during rest, as well as a blunted BP response and increased LF-HRV during HGT (a dagger systolic 22 mm Hg; a dagger LF(nu) 27%) compared with controls (a dagger systolic 27; a dagger LF(nu) 6%). Locally, the pain group had attenuated trapezius MBF in response to HGT (Pain 122% Control 140%) with elevated trapezius EMG following HGT and during CPT. In conclusion, only HGT showed differences between groups in systemic BP and HRV and alterations in local trapezius MBF and EMG in the pain group. Findings support the hypothesis of ANS involvement at systemic and local levels in chronic neck-shoulder pain.

Keyword
Muscle pain, Sympathetic, Heart rate variability, PPG, Electromyography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-158328 (URN)10.1007/s00421-010-1813-z (DOI)000293980000019 ()
Available from: 2011-09-06 Created: 2011-09-06 Last updated: 2017-12-08Bibliographically approved
2. Autonomic regulation, physical activity and perceived stress in subjects with musculoskeletal pain: 24-hour ambulatory monitoring
Open this publication in new window or tab >>Autonomic regulation, physical activity and perceived stress in subjects with musculoskeletal pain: 24-hour ambulatory monitoring
2012 (English)In: International Journal of Psychophysiology, ISSN 0167-8760, E-ISSN 1872-7697, Vol. 86, no 3, 276-282 p.Article in journal (Refereed) Published
Keyword
Daily physical activity, Ambulatory monitoring, Heart rate variability, Trapezius myalgia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-187526 (URN)10.1016/j.ijpsycho.2012.09.017 (DOI)000312521700011 ()
Available from: 2012-12-07 Created: 2012-12-07 Last updated: 2017-12-07Bibliographically approved
3. Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study
Open this publication in new window or tab >>Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study
Show others...
2011 (English)In: Applied Psychophysiology and Biofeedback, ISSN 1090-0586, E-ISSN 1573-3270, Vol. 36, no 2, 71-80 p.Article in journal (Refereed) Published
Abstract [en]

Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.

Keyword
Heart rate variability, Biofeedback, ANS, Neck pain, Stress tests
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-148579 (URN)10.1007/s10484-011-9147-0 (DOI)000290026100002 ()21365308 (PubMedID)
Available from: 2011-03-08 Created: 2011-03-08 Last updated: 2017-12-11Bibliographically approved
4. Physical activity and autonomic regulation in workers with chronic neck-shoulder pain - monitoring during work and leisure time
Open this publication in new window or tab >>Physical activity and autonomic regulation in workers with chronic neck-shoulder pain - monitoring during work and leisure time
(English)Article in journal (Refereed) Submitted
Keyword
Heart rate variability, Trapezius myalgia, Sympathetic, Parasympathetic, Perceived stress, Daily physical activity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-187529 (URN)
Available from: 2012-12-07 Created: 2012-12-07 Last updated: 2013-07-25Bibliographically approved

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