Heart Rate Variability and Non Pain Medical Researchers Who Fully Embrace HRV Studies – Why Don’t We?

Dear Pain Matters blog readers,

Who has pain? 

Here are some sobering statistics:

Moderate to severe intensity of chronic pain affects 1 in 5 (19%) adults in Europe, hence adversely impacting on the social and working lives of these chronic pain sufferers.  Furthermore, 6.9% – 10% of the population suffers from nerve pain (neuropathic pain).  Other studies report the incidence of nerve pain closer to 7% – 8%.  In cancer, nerve pain affects 2 in 5 (39%) cancer patients with pain.

So if you suffer from nerve pain and/or chronic pain, you are certainly not alone!

Heart Rate Variability (HRV)

Given the vast numbers of nerve pain and/or chronic pain sufferers, research into heart rate variability (HRV) and its potential usefulness as an (additional) diagnostic tool for the assessment of pain intensity is warranted.

The measurement of HRV may (also) be useful to assess the effectiveness of pain treatments, ‘before‘, ‘during‘, and ‘after‘ treatments including pain medication.

Heart rate variability monitoring is non-invasive and relatively inexpensive.  Real-time HRV data can even be collected in the privacy of a pain patient’s own home (via a small device) for a certain period of time (minutes, hours, or even days at a time) by the pain researcher.  This data can be downloaded, and forwarded for HRV analysis at a centralized medical/research location (see papers by Litscher et al).

While selected studies involving HRV and pain are published, many more studies involving pain and HRV are needed.  Research funding should be directed into HRV and nerve pain/chronic pain/acute pain/cancer pain.

There are many HRV experts including Thayer et al and Litscher et al.  However, most of these HRV experts are  dedicated to non pain research.

For example, an entire section in a journal called Evidence-Based Complementary and Alternative Medicine is solely dedicated to studies involving HRV.  This section, called Heart Rate Variability and Complementary Medicine 2014, lists seventeen (17) HRV-related studies (see References)!

In my humble opinion, it would be nice to see a similarly long and impressive list of studies solely dedicated to HRV and nerve pain/chronic pain.

Heart rate variability monitoring in pain patients may complement current diagnostic methods including the McGill Pain Questionnaire.

Finally, comparison of HRV results ‘before‘, ‘during‘, and ‘after‘ pain treatments may offer additional insight into the effectiveness of these pain treatments including pain medication.

Sabina Walker

Master Appl. Science (Neuroscience)

With an academic interest in ‘HRV and Nerve Pain’

References:

References for ‘Who has pain?’:

(1) Breivik et al; Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment; Eur J Pain (May 2006); 10(4), Pages 287-333.

http://www.ncbi.nlm.nih.gov/pubmed/16095934

(2) van Hecke et al; Neuropathic pain in the general population: A systematic review of epidemiological studies; Pain (April 2014); 155(4), Pages 654-662.

http://www.painjournalonline.com/article/S0304-3959(13)00610-6/abstract

(3) Piano et al; Treatment for neuropathic pain in patients with cancer: comparative analysis of recommendations in national clinical practice guidelines from European countries; Pain Pract (Jan 2014); 14(1), Pages 1-7.

doi: 10.1111/papr.12036.

http://www.ncbi.nlm.nih.gov/pubmed/23360414

References for ‘Heart Rate Variability (HRV)’:

 

(4.0) Litscher G, He W, Yi S-H, Wang L (Guest Editors);

Heart Rate Variability and Complementary Medicine 2014 (Annual Special Issue); Evidence-Based Complementary and Alternative Medicine.

Includes the following HRV-related papers:

(4.1) Impact of Colored Light on Cardiorespiratory Coordination

(4.2) Auricular Acupressure to Improve Menstrual Pain and Menstrual Distress and Heart Rate Variability for Primary Dysmenorrhea in Youth with Stress

(4.3) The Influence of New Colored Light Stimulation Methods on Heart Rate Variability, Temperature, and Well-Being: Results of a Pilot Study in Human

(4.4) Pilot Study of Acupuncture Point Laterality: Evidence from Heart Rate Variability

(4.5) Manual Acupuncture and Laser Acupuncture for Autonomic Regulations in Rats: Observation on Heart Rate Variability and Gastric Motility

(4.6) Heart Rate Variability and Hemodynamic Change in the Superior Mesenteric Artery by Acupuncture Stimulation of Lower Limb Points: A Randomized Crossover Trial

(4.7) Effectiveness of Interstitial Laser Acupuncture Depends upon Dosage: Experimental Results from Electrocardiographic and Electrocorticographic Recordings

(4.8) Continuous Auricular Electroacupuncture Can Significantly Improve Heart Rate Variability and Clinical Scores in Patients with Depression: First Results from a Transcontinental Study

(4.9) Improvement of the Dynamic Responses of Heart Rate Variability Patterns after Needle and Laser Acupuncture Treatment in Patients with Burnout Syndrome: A Transcontinental Comparative Study

(4.10) The Physical Effects of Aromatherapy in Alleviating Work-Related Stress on Elementary School Teachers in Taiwan

(4.11) Auricular Acupuncture at the “Shenmen” and “Point Zero” Points Induced Parasympathetic Activation

(4.12) Laser Acupuncture: Two Acupoints (Baihui, Neiguan) and Two Modalities of Laser (658 nm, 405 nm) Induce Different Effects in Neurovegetative Parameters

(4.13) Effects of Acupuncture on Heart Rate Variability in Beagles; Preliminary Results, Huan Wang, Gerhard Litscher, Xian Shi, Yue Bo Jiang, and Lu Wang

(4.14) Heart Rate Variability and Complementary Medicine

(4.15) Effect of Acupuncture on Heart Rate Variability: A Systematic Review

(4.16) Intravenous Laser Blood Irradiation, Interstitial Laser Acupuncture, and Electroacupuncture in an Animal Experimental Setting: Preliminary Results from Heart Rate Variability and Electrocorticographic Recordings

(4.17) Ear Acupressure, Heart Rate, and Heart Rate Variability in Patients with Insomnia

http://www.hindawi.com/journals/ecam/variability.complementary.medicine/

(5.1) In English –

Krzysztof Kudryski

Analysis of Heart Rate Variability Signal

ISBN10 3838372360
ISBN13 9783838372365

(5.2) In German –

Jens-Falk Heimann, Nicole Franke-Gricksch

Der Puls des Lebens – Die Signale des Herzens verstehen (2015; 208 pages)

ISBN-13: 9783944697024
ISBN-10: 3944697022

CRPS Video on CRPS by PARC (a CRPS website)

Dear Pain Matters blog readers,

An excellent, 20-minute documentary video (available on DVD) about the impact of complex regional pain syndrome (CRPS) on 4 CRPS sufferers has just been brought to my attention.

This video/DVD is called:

DVD: LIVING A LIFE IN PAIN:

THE STORY OF RSD/CRPS

By Sarah Panas

This DVD, by film maker, Sarah Panas (Winnipeg, Manitoba), can be ordered from PARC for $10 plus shipping:

http://www.rsdcanada.org/parc/english/parc/news.htm

 

This video is also accompanied by a 5-minute trailer:

‘Living a Life in Pain: The Story of RSD/CRPS – Trailer’:

http://www.youtube.com/watch?v=uB1TPVND9iU

 

Four (4) CRPS patients are featured in this documentary, plus trailer.

Pain Specialist (Dr David Shulman) and Psychologist (Dr Matthew Bailly) are also interviewed.  It is worth adding that in 2008, Dr Shulman rode halfway across Canada on a bicycle, totalling 3,750 km, to raise funds for CRPS research!

Here is a sample of eye-opening comments about CRPS made by the 4 CRPS patients (excerpts only – see video and trailer for full comments):

CRPS Patient #1, Richard Panas, who uses a cane and a wheelchair due to CRPS, describes the painful experience of CRPS as follows (quoting):

“…. RSDS [aka CRPS] …..is a nightmare!  It’s the worst thing ever! …..I could have plans to go somewhere, and I can’t even walk! ….and I don’t think there’s too many people that’ve been in that amount of pain………I used to explain the pain in my leg like someone ripped open my skin and was scraping the bones with a spoon, and it was the best way I could explain the pain…..and if it wasn’t for my kids, Sarah and Jamie, I really believe I wouldn’t be here.”

CRPS Patient #2, Paula Orecklin, a young CRPS patient who uses a cane due to CRPS, describes CRPS as follows (quoting):

“….At this point, I am literally waiting for the next medical breakthrough.  I’m waiting for the next paper, because I have tried it all…..Even though you can’t see my disease, it is there.  Believe me when I say it! … This is as much pain as you can be in, and keep going, as far as I can tell….It’s hard to look in my future and be all that optimistic, sometimes.”

CRPS Patient #3, Willy Noiles, CRPS patient and PARC Board Member, adds (quoting):

“I would describe the pain as a burning pain. It’s almost like your leg is on fire at times, and at other times, it’s almost like someone is jabbing something into you.”

CRPS Patient #4, Helen Small, CRPS patient and PARC Executive Director, states (quoting):

“The pain is out of proportion to the injury.  So if you drop a coffee jar on your foot and you can’t walk, people don’t believe you….”

Some sobering statistics are also provided in the 5-minute trailer (quoting a sample):

“1 in 60 has a lifetime risk of getting RSD/CRPS…..”

“There is no cure, or way to test for it.”

(Note to blog readers:  More on this in future blog posts…)

“Reflex Sympathetic Dystrophy Syndrome, or Complex Regional Pain Syndrome (RSD/CRPS) is a neuropathic pain condition.”

“Treatments vary from analgesics, opioids, antidepressants to medical marijuana.”

So where to from here?

We know that there are 1000’s of CRPS patients in the world.

The good news is that there are also 1000’s of pain researchers as well as 1000’s of pain specialists out there.

On top of this, there are millions and millions of compassionate people.

So let’s all put our heads together, and see what we can collectively come up with to help patients with CRPS as well as other nerve pain disorders.

Let’s end on a positive note today, and tell these CRPS patients that they are not alone.  We will be there for them, and with them.

This Pain Matters blog is about finding papers and articles that may offer hope and inspiration for CRPS patients, as well as other patients with nerve pain.

Sabina Walker

My journey with chronic pain began because someone I know has complex regional pain syndrome following crush injury.

Dear pain sufferers and supporters:

I decided to start this blog mainly as a way to reach out to as many neuropathic pain sufferers (and supporters) as possible.

This blog will explore ways that we can all (collectively) help people with neuropathic pain, whether it is to increase awareness of neuropathic pain, support our academic pain researchers better, stimulate pain research into novel pain research areas, raise awareness of the need to increase pain management resources including reduced wait times, more pain specialists/pain doctors, etc.

(Hopefully this is my small way to help make this planet a little bit better, one step at a time.)

Since this blog is dedicated to all people with neuropathic pain (regardless of nationality, religion, skin colour, language, culture, age, gender, etc), I would also like to invite your own ‘pain stories’. I would also like to hear from former pain sufferers, since your stories will inspire and offer hope to those currently suffering from pain.

I will endeavour to share some promising academic research studies, in order to offer further hope. There is so much great work being done out there! I will invite academic researchers to share their exciting developments with you. After all, given that these researchers have voluntarily chosen to do pain research (instead of some other job like banking or farming, etc), then, presumably, they are also there for neuropathic pain patients!

I would like to invite correspondence from caring pain specialists too. Without them, many pain patients would be much worse off. In fact, many patients are no longer in pain because of many talented and caring pain clinicians!

In summary, this blog is about helping patients with neuropathic pain, whether this is by raising awareness or otherwise.

This blog is also about the unsung heroes who are involved in pain research (both past and present), as well as those who are involved in the clinical and professional medical care of pain patients.

Last, but not least, this blog is about anyone, and everyone, with compassion for those who endure neuropathic pain.

Let us begin this journey together via this blog! After all, Pain Matters!

See you tomorrow!

Sabina Walker
Master Appl. Sc. (Neuroscience)