Assessment of the autonomic nervous system in patients with chronic low back pain
DOI:
https://doi.org/10.32782/2077-6594/2024.3/19Keywords:
lower back pain, back pain, autonomic nervous system, sympathetic nervous system diseases, autonomic dysfunctionsAbstract
Purpose: of the study was to assess the characteristics of the autonomic nervous system in patients with chronic low back pain in order to identify dysfunction and further optimize treatment. Materials and methods. A questionnaire based on the Wayne’s questionnaire and an orthostatic test were administered to 80 people aged 18–60 years with chronic low back pain (low back pain lasting >3 months). Results. The study involved 80 patients with a mean age of 33,7 ± 12,3, including 53 women (66%) and 27 men (34%). The mean value of the number of points obtained on Wayne’s questionnaire was 25 ± 13,84 points, which corresponds to signs of autonomic dysfunction. Among the subjects, 75% had signs of autonomic dysfunction and only 25% had a normal state of the ANS. We found a weak positive statistically significant correlation between pain intensity and the degree of autonomic dysfunction r = 0,241, p = 0,04. According to the results of the orthostatic test, we found that 43% of women and 24% of men had an increased tone of the sympathetic part of the ANS. Conclusions. About 75% of people with chronic low back pain had signs of autonomic dysfunction according to the Wayne’s List questionnaire. Women with chronic low back pain are more prone to autonomic dysfunction compared to men. A weak positive statistically significant correlation was found between pain intensity and the degree of autonomic dysfunction according to Wayne’s questionnaire. Increased tone of the sympathetic part of the ANS according to the orthostatic test is twice as common in women as in men.
References
Huang Y, Li C, Chen J, et al. Multidimensional risk factor analysis of acute low back pain progressing to chronicity: a longitudinal cohort study protocol. Front Med (Lausanne). 2023; 10: 1194521. Published 2023 Jun 26. DOI: 10.3389/fmed.2023.1194521.
Shiri R, Falah-Hassani K, Heliövaara M, et al. Risk Factors for Low Back Pain: A Population-Based Longitudinal Study. Arthritis Care Res (Hoboken). 2019; 71 (2): 290–299. DOI: 10.1002/acr.23710.
Saxena Navneet Krishna, Sankaralal T. Evaluation of causes and preventive measures of low back pain: A retrospective study. International Journal of Orthopaedics. 7.3 (2021): 169–174. DOI: 10.22271/ORTHO.2021.V7.I3C.2742.
Hochheim M, Ramm P, Wunderlich M, Amelung V. Association between chronic low back pain and regular exercise, sedentary behaviour and mental health before and during COVID-19 pandemic: insights from a large-scale cross-sectional study in Germany. BMC Musculoskelet Disord. 2022; 23 (1): 860. Published 2022 Sep 15. DOI: 10.1186/s12891-022-05806-8.
Bento TPF, Genebra CVDS, Maciel NM, Cornelio GP, Simeão SFAP, Vitta A. Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther. 2020; 24 (1): 79–87. DOI: 10.1016/j.bjpt.2019.01.012.
Hnatešen D, Pavić R, Radoš I, et al. Quality of Life and Mental Distress in Patients with Chronic Low Back Pain: A Cross-Sectional Study. Int J Environ Res Public Health. 2022; 19 (17): 10657. Published 2022 Aug 26. DOI: 10.3390/ijerph191710657.
Vlaeyen JWS, Maher CG, Wiech K, et al. Low back pain. Nat Rev Dis Primers. 2018; 4 (1): 52. Published 2018 Dec 13. DOI: 10.1038/s41572-018-0052-1.
Urits I, Burshtein A, Sharma M, et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019; 23 (3): 23. Published 2019 Mar 11. DOI: 10.1007/s11916-019-0757-1.
Hautala AJ, Karppinen J, Seppanen T. Short-term assessment of autonomic nervous system as a potential tool to quantify pain experience. Annu Int Conf IEEE Eng Med Biol Soc. 2016; 2016: 2684–2687. DOI: 10.1109/EMBC.2016.7591283.
Nahman-Averbuch H, Coghill RC. Pain-autonomic relationships: implications for experimental design and the search for an “objective marker” for pain. Pain. 2017; 158 (11): 2064–2065. DOI: 10.1097/j.pain.0000000000001035.
Hohenschurz-Schmidt DJ, Calcagnini G, Dipasquale O, et al. Linking Pain Sensation to the Autonomic Nervous System: The Role of the Anterior Cingulate and Periaqueductal Gray Resting-State Networks. Front Neurosci. 2020; 14: 147. Published 2020 Feb 27. DOI: 10.3389/fnins.2020.00147.
Bantel C, Trapp S. The role of the autonomic nervous system in acute surgical pain processing – what do we know? Anaesthesia. 2011; 66 (7): 541–544. DOI: 10.1111/j.1365-2044.2011.06791.x.
Kruglov D, McGuckin D. The Role of Autonomic Nervous System in Pain Chronicity. 2023. DOI: 10.5772/intechopen.112154.
Arslan D, Ünal Çevik I. Interactions between the painful disorders and the autonomic nervous system. Otonom sinir sistemi ve ağrılı bozukluklar arasındaki etkileşimler. Agri. 2022; 34 (3): 155–165. DOI: 10.14744/agri.2021.43078
Prim JH, Ahn S, Davila MI, Alexander ML, McCulloch KL, Fröhlich F. Targeting the Autonomic Nervous System Balance in Patients with Chronic Low Back Pain Using Transcranial Alternating Current Stimulation: A Randomized, Crossover, Double-Blind, Placebo-Controlled Pilot Study. J Pain Res. 2019; 12: 3265–3277. Published 2019 Dec 11. DOI: 10.2147/JPR.S208030.
Abuín-Porras V, Clemente-Suárez VJ, Jaén-Crespo G, Navarro-Flores E, Pareja-Galeano H, Romero-Morales C. Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain. Journal of Clinical Medicine. 2021; 10 (8): 1793. https://doi.org/10.3390/jcm10081793.
He Wei, et al. Modulation of autonomic nervous system during and after acupuncture treatment of lumbosacral pain in women: a preliminary clinical observational study. Medical Acupuncture, 2013, 25.3: 209–215. DOI: 10.1089/ACU.2012.0884.
Pontes-Silva A, Bassi-Dibai D, Fidelis-de-Paula-Gomes CA, et al. Comparison of the autonomic nervous system dysfunction between different chronic spine disorders: neck pain versus low back pain. Rev Assoc Med Bras (1992). 2022; 68 (9): 1288–1296. DOI: 10.1590/1806-9282.20220406.
Telles S, Sharma SK, Gupta RK, Bhardwaj AK, Balkrishna A. Heart rate variability in chronic low back pain patients randomized to yoga or standard care. BMC Complement Altern Med. 2016; 16 (1): 279. Published 2016 Aug 11. DOI: 10.1186/s12906-016-1271-1.
Shankar N, Thakur M, Tandon OP, Saxena AK, Arora S, Bhattacharya N. Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial. Indian J Physiol Pharmacol. 2011; 55 (1): 25–36.
