Night time heart rate predicts next-day pain in fibromyalgia and primary back pain

Introduction: Primary chronic pain is pain that persists for over 3 months without associated measurable tissue damage. One of the most consistent findings in primary chronic pain is its association with autonomic hyperactivation. Yet whether the autonomic hyperactivation causes the pain or results from it is still unclear. It is also unclear to what extent autonomic hyperactivation is related to experienced pain intensity in different subtypes or primary chronic pain. Objectives: Our first aim was to test lagged relationships between the markers of autonomic activation (heart rate) and pain intensity to determine its directionality. The main question here was whether autonomic biomarkers predict pain intensity or whether pain intensity predicts autonomic biomarkers. The second aim was to test whether this relationship is different between people with primary back pain and people with fibromyalgia. Methods: Sixty-six patients with chronic pain were observed over an average of 81 days. Sleep heart rate and heart rate variability were measured with a wearable sensor, and pain intensity was assessed from daily subjective reports. There was no interaction with the type of chronic pain. Conclusions: increases in primary chronic pain. Moreover, the present results suggest that autonomic hyperactivation is a common mechanism underlying the pain experience in fibromyalgia and chronic back pain.