Oura Petteri, Hautala Arto, Kiviniemi Antti, Auvinen Juha, Puukka Katri, Tulppo Mikko, Huikuri Heikki, Seppänen Tapio, Karppinen Jaro
Faculty of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.
Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.
BMC Musculoskelet Disord. 2019 Jan 31;20(1):45. doi: 10.1186/s12891-019-2426-2.
Heart rate variability (HRV) and baroreflex sensitivity (BRS) measurements provide means for the objective assessment of cardiovascular autonomic function. As previous studies have associated chronic pain with abnormal autonomic function, we aimed to characterize the relationship between the number of musculoskeletal pain sites (NPS), pain intensity, and cardiovascular autonomic function among the population-based Northern Finland Birth Cohort 1966.
At the age of 46, cohort members self-reported their musculoskeletal pains (enabling the determination of NPS [0-8] and pain intensity [Numerical Rating Scale, NRS, 0-10]) and underwent clinical assessments of cardiovascular autonomic function in seated and standing positions (HRV variables: heart rate [HR] and root mean square of successive differences in beat-to-beat intervals [rMSSD] for the entire cohort; BRS variables: low-frequency systolic blood pressure variability [SBPV] and cross-spectral baroreflex sensitivity [BRS] for those attending the examination in Oulu, Finland). Extensive confounder data were also collected (body mass index, physical activity, smoking, Hopkins Symptom Checklist-25, comorbidities, and medications). The full samples included 4186 and 2031 individuals (HRV and BRS samples, respectively). Three subanalyses focused on individuals with intense and frequent pain, individuals with symptoms of depression and anxiety, and the relationship between pain intensity and autonomic parameters.
Linear regression models showed varying associations between NPS, pain intensity, and cardiovascular autonomic parameters. However, after all adjustments NPS was only associated with one outcome among women (BRS, standing: beta = - 0.015, p = 0.048) and two among men (HR, seated: beta = - 0.902, p = 0.003; HR, standing: beta = - 0.843, p = 0.014). Pain intensity was not associated with any outcome after full adjustments. Significant sex*pain interactions were found in the data.
Our data suggest that musculoskeletal pain has, at most, a limited independent association with cardiovascular autonomic function. Future studies should carefully account for the potential confounders and sex interactions that this study revealed.
心率变异性（HRV）和压力反射敏感性（BRS）测量为心血管自主神经功能的客观评估提供了手段。由于先前的研究已将慢性疼痛与自主神经功能异常相关联，我们旨在描述1966年芬兰北部出生队列人群中肌肉骨骼疼痛部位数量（NPS）、疼痛强度与心血管自主神经功能之间的关系。
在46岁时，队列成员自我报告其肌肉骨骼疼痛情况（从而确定NPS[0 - 8]和疼痛强度[数字评分量表，NRS，0 - 10]），并在坐位和站立位接受心血管自主神经功能的临床评估（HRV变量：全队列的心率[HR]和逐搏间期连续差值的均方根[rMSSD]；BRS变量：芬兰奥卢参加检查者的低频收缩压变异性[SBPV]和交叉谱压力反射敏感性[BRS]）。还收集了大量混杂因素数据（体重指数、身体活动、吸烟、霍普金斯症状清单 - 25、合并症和药物）。完整样本分别包括4186人和2031人（HRV和BRS样本）。三项亚分析分别聚焦于疼痛剧烈且频繁的个体、有抑郁和焦虑症状的个体以及疼痛强度与自主神经参数之间的关系。
线性回归模型显示NPS、疼痛强度与心血管自主神经参数之间存在不同的关联。然而，在进行所有调整后，NPS仅与女性的一项结果相关（站立位BRS：β = - 0.015，p = 0.048），与男性的两项结果相关（坐位HR：β = - 0.902，p = 0.003；站立位HR：β = - 0.843，p = 0.014）。在进行全面调整后，疼痛强度与任何结果均无关联。数据中发现了显著的性别*疼痛交互作用。
我们的数据表明，肌肉骨骼疼痛与心血管自主神经功能至多存在有限的独立关联。未来的研究应仔细考虑本研究揭示的潜在混杂因素和性别交互作用。
