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Heart rate variability as a biomarker for autonomic nervous system response differences between children with chronic pain and healthy control children

Authors Evans S, Seidman L, Tsao J, Lung, Zeltzer L, Naliboff B

Received 9 February 2013

Accepted for publication 27 March 2013

Published 12 June 2013 Volume 2013:6 Pages 449—457

DOI https://doi.org/10.2147/JPR.S43849

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Subhadra Evans,1 Laura C Seidman,1 Jennie CI Tsao,1 Kirsten C Lung,1 Lonnie K Zeltzer,1 Bruce D Naliboff2

1Pediatric Pain Program, University of California, Los Angeles, CA, USA; 2Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA

Abstract: Studies in adults have demonstrated a relationship between lowered heart rate variability (HRV) and poor health. However, less is known about the role of autonomic arousal in children's well-being. The aim of the current study was to examine resting HRV in children with chronic pain compared to healthy control children and, further, to examine children's HRV following a series of acute experimental pain tasks in both groups. Participants included 104 healthy control children and 48 children with chronic pain aged 8–17 years. The laboratory session involved a 5-minute baseline electrocardiogram followed by four pain induction tasks: evoked pressure, cold pressor, focal pressure, and a conditioned pain modulation task. After the tasks were complete, a 5-minute post-task electrocardiogram recording was taken. Spectral analysis was used to capture high-frequency normalized power and the ratio of low-to-high frequency band power, signifying cardiac vagal tone and sympathetic balance, respectively. Results revealed that children with chronic pain had significantly lower resting HRV (signified by low high-frequency normalized power and high ratio of low-to-high frequency band power) compared to healthy children; moreover, a significant interaction between groups and time revealed that children with chronic pain displayed a static HRV response to the pain session compared to healthy children, whose HRV was reduced concomitant with the pain session. These findings suggest that children with chronic pain may have a sustained stress response with minimal variability in response to new acute pain stressors.

Keywords: laboratory pain, pediatric pain, cold pressor, experimental pain, childhood pain, stress task

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