Cardiac vagal tone as a reliable index of pain chronicity and severityстатья
Статья опубликована в высокорейтинговом журнале
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Дата последнего поиска статьи во внешних источниках: 10 августа 2018 г.
Аннотация:Compared with RSA, only a few studies in chronic pain
research have used measures of cardiac baroreceptor reflex for
assessing vagal activity. Paradoxically, but despite its low
popularity, this reflex is a better predictor of parasympathetic
cardiac control than RSA. In those few cases when RSA and
baroreflex metrics are used together in chronic pain research,
their combined reliability is rarely compared with assess and
predict pain chronicity and severity. This obscures the
impact of related autonomic mechanisms on chronic pain
development. Although linear during normal physiological states,
the relationship between RSA and cardiac vagal tone as
manipulated by baroreflex-mediated effects is quadratic across
the entire range.
In 2 recent articles, our group has tried to compare baroreflex and
HRV-derived metrics of vagal tone regulation by their
dependent (mediation) and independent paths for predicting
pain severity and chronicity in patients with FAP and their role in
the possible exacerbation of pain severity by affective processes.
The findings confirmed the prediction that the HF-HRV
metric only partly indicated vagal tone regulation as determined
by baroreflex activity, and that this mechanism was the only one
associated with affect-related “pain aggravation” (affect comorbidity).
Other baroreflex-related mechanisms related to pain
chronicity and severity independent of affect were designated as
“pain resilience” (decreased baroreflex tachycardia for increasing
acute pain threshold); “pain decompensation” (decreased
baroreflex bradycardia for increasing acute pain sensitivity); and
“pain adaptation” (reduced parasympathetic “braking” of sympathetic
activity for increasing chronic pain tolerance). We
propose validating different sophisticated and simplified
baroreflex-related metrics as generic biomarkers of pain
severity and duration and of pain suffering and pain coping
mechanisms in other chronic pain syndromes to better patient
profiling and correct management.