Key result
Effective analgesic self-medication for persistent pain is linked to greater vmHRV versus ineffective intake.
Why the study?
Does effective analgesic self-medication improve vagally mediated heart rate variability in individuals with persistent pain?
Cross-Sectional
Does effective analgesic self-medication improve vagally mediated heart rate variability in individuals with persistent pain?
Effective analgesic self-medication is associated with restored vagally mediated heart rate variability, suggesting the vagus nerve may serve as an objective indicator of pain severity and treatment efficacy.
Hypothesis-generating for vagal HRV as analgesic efficacy marker in persistent pain; prospective studies needed before clinical adoption.
OBJECTIVE: Persistent pain is associated with dysfunction of the autonomic nervous system, in particular a loss of vagal inhibitory control, that can be indexed by decreased vagally mediated heart rate variability (vmHRV). Effective treatment (e.g., analgesic self-medication) may lead to a restoration of vmHRV. The objective of this article was to further explore the relationship of pain and vagal control and to investigate the effect of analgesic self-medication on the association of vmHRV and pain. METHODS: We used a large cross-sectional data set on pain ratings and analgesic intake from the Mannheim Industrial Cohort Study for secondary analysis. The root mean square of successive differences, a measure of vmHRV corresponding to the parasympathetic regulation of the heart, was derived from 24-hour electrocardiogram recordings. RESULTS: The frequency of analgesic intake and interference of pain are significantly associated. Individuals that report greater pain interference with their normal work routine (including both work outside the home and housework) and frequent analgesic intake have significantly lower vmHRV. Subjects with ineffective analgesic intake (reporting great pain interference and high frequent analgesic intake) had the lowest vmHRV. Individuals effectively taking analgesics (reporting no or low pain interference and high frequent analgesic intake) showed greater vmHRV compared to those ineffectively taking. Analysis revealed significant differences and linear trends on vmHRV between all groups. CONCLUSION: In line with previous research, vmHRV is inversely associated with pain interference. Analgesic intake mediates the association of vmHRV and pain. Effective analgesic self-medication may lead to a restoration in vmHRV. These results further support the vagus nerve as an objective indication of pain severity and treatment efficacy in patients with persistent pain.
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Koenig et al. (2015) conducted a cross-sectional in Persistent pain. Analgesic intake and pain interference vs. Ineffective analgesic intake or low pain interference was evaluated on Vagally mediated heart rate variability (vmHRV) measured by root mean square of successive differences. Effective analgesic self-medication in individuals with persistent pain was associated with greater vagally mediated heart rate variability compared to ineffective analgesic intake.
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