Heart rate and heart rate variability as outcomes and longitudinal moderators of treatment for pain across follow-up in Veterans with Gulf War illness

Mathersul, Danielle; Dixit, Kamini; Avery, Timothy J.; Schulz-Heik, R. Jay; Zeitzer, Jamie M.; Mahoney, Louise; Cho, Rachael H.; Bayley, Peter J.

doi:10.1016/j.lfs.2021.119604

Cited by 6 publications

(12 citation statements)

References 72 publications

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“…Interestingly, normalised HF-HRV showed more robust findings than absolute HF-HRV, consistent with the notion that it is a more valid measure than absolute HF-HRV for betweensubject comparisons (like treatment group by time interactions) [48]. Indeed, we previously found different patterns of findings for absolute versus normalised HF-HRV [53] and note that studies do not always report on exact parameters -nor do they report multiple time-and frequency-domain indices -highlighting the need for consistency, breadth, and replication across HRV indices. While our ITT analyses did not reach significance threshold for any HRV indices, exploratory follow-up effect size comparisons demonstrated similar patterns to the per protocol analyses, particularly for SKY versus CPT, with the strongest effects for per protocol.…”

Section: Discussionsupporting

confidence: 85%

“…SDNN generally reflects parasympathetically-mediated RSA, is highly correlated with HR, and lower values predict morbidity and mortality [48]. We have previously found different patterns of results for normalised versus absolute HF-HRV [53] and note that studies do not always report on exact parameters. Thus, we include both HF-HRV values as indices of parasympathetic activation [44,45], though normalised HF-HRV has also been proposed as a measure of ANS balance [41].…”

Section: Physiological Er: Heart Rate Variability (Hrv)mentioning

confidence: 99%

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Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial

et al. 2022

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Background Emotion regulation (ER) is a key process underlying posttraumatic stress disorder (PTSD), yet, little is known about how ER changes with PTSD treatment. Understanding these effects may shed light on treatment processes. Methods We recently completed a non-inferiority design randomised controlled trial demonstrating that a breathing-based yoga practice (Sudarshan kriya yoga; SKY) was not clinically inferior to cognitive processing therapy (CPT) across symptoms of PTSD, depression, or negative affect. Here, in secondary exploratory analyses (intent-to-treat N = 85; per protocol N = 59), we examined whether self-reported ER (Difficulties in Emotion Regulation Scale; DERS) and physiological ER (heart rate variability; HRV) improved with treatment for clinically significant PTSD symptoms among US Veterans. Results DERS-Total and all six subscales improved with small-to-moderate effect sizes (d = .24–.66) following CPT or SKY, with no differences between treatment groups. Following SKY (but not CPT), HR max–min (average difference between maximum and minimum beats per minute), LF/HF (low-to-high frequency) ratio, and normalised HF-HRV (high frequency power) improved (moved towards a healthier profile; d = .42–.55). Conclusions To our knowledge, this is the first study to demonstrate that a breathing-based yoga (SKY) improved both voluntary/intentional and automatic/physiological ER. In contrast, trauma-focused therapy (CPT) only reliably improved self-reported ER. Findings have implications for PTSD treatment and interventions for emotional disorders more broadly. Trial registration Secondary analyses of ClinicalTrials.gov NCT02366403.

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Section: Discussionsupporting

confidence: 85%

Section: Physiological Er: Heart Rate Variability (Hrv)mentioning

confidence: 99%

Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial

et al. 2022

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“…The initial literature search identified 968 studies published between 1973 and 2022, and after removing duplicates, reviewing the titles and abstracts, and reading the full texts, 15 studies were selected. Five investigated experimental pain (Appelhans & Luecken, 2008; Jiang et al, 2022; Nahman‐Averbuch et al, 2014; Tracy, Koenig, et al, 2018; Umeda & Okifuji, 2022), five investigated postoperative pain (Adjei et al, 2017; Boselli et al, 2014; Caton et al, 2021; Powezka et al, 2019; Verweij et al, 2021) and five investigated longitudinal changes in clinical pain (Allen et al, 2018; Baron et al, 1997; Bossmann et al, 2017; Kovacic et al, 2020; Mathersul et al, 2021). However, the heterogeneity within these studies did not allow for a meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“… Note : 1 Baron et al (1997), 2 Appelhans & Luecken (2008), 3 Boselli et al (2014), 4 Nahman‐Averbuch et al (2014), 5 Adjei et al (2017), 6 Bossmann et al (2017), 7 Allen et al (2018), 8 Tracy, Koenig, et al (2018), 9 Powezka et al (2019), 10 Kovacic et al (2020), 11 Caton et al (2021), 12 Mathersul et al (2021), 13 Verweij et al (2021), 14 Jiang et al (2022), 15 Umeda & Okifuji (2022). …”

Section: Literature Search Methodsmentioning

confidence: 99%

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Prediction of pain using electrocardiographic‐derived autonomic measures: A systematic review

Wegeberg,

Sejersgaard‐Jacobsen,

Brock

et al. 2023

European Journal of Pain

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Background and ObjectivePain is a major clinical challenge, and understanding the pathophysiology is critical for optimal management. The autonomic nervous system reacts to pain stimuli, and autonomic dysfunction may predict pain sensation. The most used assessment of autonomic function is based on electrocardiographic measures, and the ability of such measures to predict pain was investigated.Databases and Data TreatmentEnglish articles indexed in PubMed and EMBASE were reviewed for eligibility and included when they reported electrocardiographic‐derived measures’ ability to predict pain response. The quality in prognostic studies (QUIPS) tool was used to assess the quality of the included articles.ResultsThe search revealed 15 publications, five on experimental pain, five on postoperative pain, and five on longitudinal clinical pain changes, investigating a total of 1069 patients. All studies used electrocardiographically derived parameters to predict pain assessed with pain thresholds using quantitative sensory testing or different scales. Across all study modalities, electrocardiographic measures were able to predict pain. Higher parasympathetic activity predicted decreased experimental, postoperative, and long‐term pain in most cases while changes in sympathetic activity did not consistently predict pain.ConclusionsMost studies demonstrated that parasympathetic activity could predict acute and chronic pain intensity. In the clinic, this may be used to identify which patients need more intensive care to prevent, for example postoperative pain and develop personalized chronic pain management.SignificancePain is a debilitating problem, and the ability to predict occurrence and severity would be a useful clinical tool. Basal autonomic tone has been suggested to influence pain perception. This systematic review investigated electrocardiographic‐derived autonomic tone and found that increased parasympathetic tone could predict pain reduction in different types of pain.

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Monitoring change in heart rate variability following acceptance and commitment therapy for chronic pain: Results of a randomized controlled trial for individuals with neurofibromatosis type 1

Allen

Struemph

Toledo‐Tamula

et al. 2023

Journal of Contextual Behavioral Science

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Heart rate and heart rate variability as outcomes and longitudinal moderators of treatment for pain across follow-up in Veterans with Gulf War illness

Cited by 6 publications

References 72 publications

Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial

Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial

Prediction of pain using electrocardiographic‐derived autonomic measures: A systematic review

Monitoring change in heart rate variability following acceptance and commitment therapy for chronic pain: Results of a randomized controlled trial for individuals with neurofibromatosis type 1

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