August 1, 1999Anesthesia & Analgesia

Relief of Chronic Pain May Be Accompanied by an Increase in a Measure of Heart Rate Variability

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Chronic lower back or leg pain (n=16). Intervention: Substantial pain relief (≥50% decrease in pain scale) vs. Little pain relief (control group). Primary outcome: ≥5% increase in PD2 measure of heart rate variability.

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Key result

Substantial relief of chronic pain was associated with an increase in the PD2 measure of heart rate variability (≥5% increase in 77.8% of relief patients vs 28.6% of controls).

Why the study?

Does acute relief of chronic pain improve heart rate variability in patients with nerve root compression?

Population

16 patients with lower back or leg pain for 3 months to 1 year due to nerve root compression secondary to a…

Comparison

Substantial pain relief following caudal… vs Little pain relief following the same caudal…

Design

Cohort

Follow-up

Acute (just after treatment)

Authors

RSR. J. StorellaAllegheny College YSYoukui ShiSecond Hospital of Shandong University DODennis M. O’ConnorCalifornia State University System

Discussion

Member takes

Implication

May support PD2 as objective pain-relief marker; hypothesis-generating and should not yet change practice.

Study Design

Type

Observational (n=16)

Structured PICO

Does acute relief of chronic pain improve heart rate variability in patients with nerve root compression?

Population

16 patients with chronic lower back or leg pain due to a herniated disk who received a caudal epidural injection and were monitored for acute changes in heart rate variability.

Exposure

Substantial pain relief following caudal epidural injection of 5 mL 0.25% bupivacaine and 80 mg methylprednisolone

Comparator

Little pain relief following the same caudal epidural injection

Outcome

Changes in heart rate variability measures (PD2, SD, ApEn, mean RR interval) measured just before and after treatmentsurrogate

Main Result

Absolute Event Rate: 77.8% vs 28.6%

Acute relief of chronic pain may be accompanied by an increase in specific non-linear measures of heart rate variability (PD2), suggesting a potential objective adjunct for pain assessment.

Limitations

Small scope of the investigation limits the power of the analysis to detect significant effects on various HRV measures
Limited ability to relate the significant finding with PD2 to the wide variety of patients with chronic pain
Small sample size limits the power of the analysis to detect significant effects on various measures of HRV
Limited ability to generalize the significant finding with PD2 to the wide variety of patients with chronic pain

Cite This Study

Storella et al. (1999) conducted an observational in Chronic lower back or leg pain (n=16). Substantial pain relief (≥50% decrease in pain scale) vs. Little pain relief (control group) was evaluated on ≥5% increase in PD2 measure of heart rate variability. Substantial relief of chronic pain was associated with an increase in the PD2 measure of heart rate variability (≥5% increase in 77.8% of relief patients vs 28.6% of controls).

synapsesocial.com/papers/6a930cc1c0b3311637eb480f https://doi.org/10.1097/00000539-199908000-00037

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Relief of Chronic Pain May Be Accompanied by an Increase in a Measure of Heart Rate Variability

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Relief of Chronic Pain May Be Accompanied by an Increase in a Measure of Heart Rate Variability

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider