Skip to main content
SpringerLink
Log in

Pain Management

  • Chapter
  • First Online:
Clinical Autonomic Dysfunction

  • 1876 Accesses

Abstract

Continuing in neurology, this chapter will address P&S monitoring in pain management. Here we take data from both chronic care and critical care. The majority of the critical care applications will be presented later in that section. Pain is a stressor. The sympathetic nervous system responds to stress. Therefore, sympathetic responses may be used as an objective measure of pain responses, assuming BP is well managed. Given this premise, P&S monitoring in general helps in pain management in four ways: (1) objectively quantifying pain level, (2) differentiating the types of pain, (3) titrating therapy, and (4) documenting rehabilitation. The comorbidities associated with chronic pain are due to the effects of sympathetic excess. Quantitatively assessing sympathetic activity periodically helps to reduce the risk of high BP and hypertension, GI and sleep disorders, urogenital dysfunction, cardiovascular disease, MI, and sudden cardiac death. The last few risks are a main reason for cardiology referral from pain management. While the pain management physician is not ordering an autonomic assessment for the purposes of documenting risk of cardiovascular disease, MI, and sudden cardiac death, it is a natural outcome of the assessment as described elsewhere in this compendium. It is not the intent of the pain management physician to usurp the cardiologist, only to provide the cardiologist with the opportunity to test further and care for their patient. Recently, the field of pain management medicine has welcomed anesthesiologists.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Passatore M, Roatta S. Influence of sympathetic nervous system on sensorimotor function: whiplash associated disorders (WAD) as a model. Eur J Appl Physiol. 2006;98(5):423–49. Epub 2006 Oct 12.

    Article  PubMed  Google Scholar 

  2. Karpen J, Ortiz R, Shoemaker WC. Parasympathetic and sympathetic monitoring in pain management. Online publication at Pain.com. Accessed 14 Jan 2010.

  3. Colombo J, Shoemaker WC, Belzberg H, Hatzakis G, Fathizadeh P, Demetriades D. Noninvasive monitoring of the autonomic nervous system and hemodynamics of patients with blunt and penetrating trauma. J Trauma. 2008;65(6):1364–73.

    Article  PubMed  Google Scholar 

  4. Puzanovova M, Arboqast PG, Smith CA, Anderson J, Diedrich A, Walker LS. Autonomic activity and somatic symptoms in response to success vs. failure on a cognitive task: a comparison of chronic abdominal pain patients and well children. J Psychosom Res. 2009;67(3):235–43.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Roy RA, Boucher JP, Comtois AS. Heart rate variability modulation after manipulation in pain-free patients vs patients in pain. J Manipulative Physiol Ther. 2009;32(4):277–86.

    Article  PubMed  Google Scholar 

  6. Sandroni P. Testing the autonomic nervous system. Internat. Assoc. for the Study of Pain, Newsletter. Berde CB and Rowbotham MC (eds), 1998.

    Google Scholar 

  7. Cortelli P, Pierangeli G. Chronic pain-autonomic interactions. Neurol Sci. 2003;24:S68–70.

    PubMed  Google Scholar 

  8. Tousignant-Laflamme Y, Marchand S. Sex differences in cardiac and autonomic response to clinical and experimental pain in LBP patients. Eur J Pain. 2006;10(7):603–14.

    Article  PubMed  Google Scholar 

  9. Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Hum Dev. 2009;85(9):561–7.

    Article  PubMed Central  PubMed  Google Scholar 

  10. McCarberg B, Billington R. Consequences of neuropathic pain: quality-of-life issues and associated costs. Am J Manag Care. 2006;12:S263–8.

    PubMed  Google Scholar 

  11. Turner IM, Colombo J. Autonomic dysfunction in migraine: a case study. Headache Pain. 2004;15(4):185–93.

    Google Scholar 

  12. Shechter A, Stewart WF, Silberstein SD, Lipton RB. Migraine and autonomic nervous system function a population-based, case-control study. Neurology. 2002;58:422–7.

    Article  PubMed  Google Scholar 

  13. Meineri P, Pellegrino G, Rosso MG, Grasso E. Systemic autonomic involvement in episodic cluster headache: a comparison between active and remission periods. J Headache Pain. 2005;6:240–3.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Jänig W. Relationship between pain and autonomic phenomena in headache and other pain conditions. Cephalalgia. 2003;23 Suppl 1:43–8.

    Article  PubMed  Google Scholar 

  15. Drummond PD. Involvement of the sympathetic nervous system in complex regional pain syndrome. Lower Extrem Wounds. 2004;3(1):35–42.

    Article  Google Scholar 

  16. Cohen H, Neumann L, Kotler M, Buskila D. Autonomic nervous system derangement in fibromyalgia syndrome and related disorders. Isr Med Assoc J. 2001;3:755–60.

    CAS  PubMed  Google Scholar 

  17. Freeman R, Komaroff AL. Does the chronic fatigue syndrome involve the autonomic nervous system? Am J Med. 1997;102:357–64.

    Article  CAS  PubMed  Google Scholar 

  18. Boneva RS, Decker MJ, Maloney EM, Lin JM, Jones JF, Helgason HG, Heim CM, Rye DB, Reeves WC. Higher heart rate and reduced heart rate variability persist during sleep in chronic fatigue syndrome: a population-based study. Auton Neurosci: Basic Clin. 2007;137:94–101.

    Article  Google Scholar 

  19. Cain KC, Jarrett ME, Burr RL, Hertig VL, Heitkemper MM. Heart rate variability is related to pain severity and predominant bowel pattern in women with irritable bowel syndrome. Neurogastroenterol Motil. 2007;19(2):110–8.

    Article  CAS  PubMed  Google Scholar 

  20. Agelink MW, Boz C, Ullrich H, Andrich J. Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Res. 2002;113(1–2):139–49.

    Article  PubMed  Google Scholar 

  21. Licht CM, deGeus EJ, vanDyck R, Penninx BW. Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety (NESDA). Psychosom Med. 2009;71(5):508–18.

    Article  PubMed  Google Scholar 

  22. Carney RM, Freeland KE. Depression and heart rate variability in patients with coronary heart disease. Cleve Clin J Med. 2009;76 Suppl 2:S13–7.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Baerwald CG, Burmester GR, Krause A. Interactions of autonomic nervous, neuroendocrine, and immune systems in rheumatoid arthritis. Rheum Dis Clin North Am. 2000;26(4):841–57.

    Article  CAS  PubMed  Google Scholar 

  24. Straub RH, Baerwald CG, Wahle M, Janig W. Autonomic dysfunction in rheumatic diseases. Rheum Dis Clin North Am. 2005;31(1):61–75.

    Article  PubMed  Google Scholar 

  25. Tan BH, Shimizu H, Hiromoto K, Furukawa Y, Obvanagi M, Iwasaki T. Wavelet transform analysis of heart rate variability to assess the autonomic changes associated with spontaneous coronary spasm of variant angina. J Electrocardiol. 2003;36(2):117–24.

    Article  PubMed  Google Scholar 

  26. Burton AR, Birznieks I, Bolton PS, Henderson LA, Macefield VG. Effects of deep and superficial experimentally induced acute pain on muscle sympathetic nerve activity in human subjects. J Physiol. 2009;587(Pt 1):183–93.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Vettorello M, Colombo R, DeGrandis CE, Costantini E, Raimondi F. Effect of fentanyl on heart rate variability during spontaneous and paced breathing in healthy volunteers. Acta Anaesthesiol Scand. 2008;52(8):1064–70.

    Article  CAS  PubMed  Google Scholar 

  28. Zhang J, Dean D, Nosco D, Strazthopulos D, Floros M. Effect of chiropractic care on heart rate variability and pain in a multisite clinical study. J Manipulative Physiol Ther. 2006;29(4):267–74.

    Article  PubMed  Google Scholar 

  29. Malik M, Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;17:354–81.

    Article  Google Scholar 

  30. Tousignant-Laflamme Y, Rainville P, Marchand S. Establishing a link between heart rate and pain in healthy subjects: a gender effect. J Pain. 2006;6(6):341–7.

    Article  Google Scholar 

  31. Ray GC, Das G, Ray P. Design of EKG-based anesthesia monitor/pain monitor. Conf Proc IEEE Eng Med Biol Soc. 2004;1:25–8.

    CAS  PubMed  Google Scholar 

  32. Malik M. The Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043–65.

    Article  Google Scholar 

  33. Akselrod S, Gordon S, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuations: a quantitative probe of beat-to- beat cardiovascular control. Science. 1981;213:213–20.

    Article  Google Scholar 

  34. Akselrod S, Gordon D, Madwed JB, Snidman NC, Shannon DC, Cohen RJ. Hemodynamic regulation: investigation by spectra analysis. Am J Physiol. 1985;249:H867–75.

    CAS  PubMed  Google Scholar 

  35. Akselrod S, Eliash S, Oz O, Cohen S. Hemodynamic regulation in SHR: investigation by spectral analysis. Am J Physiol. 1987;253:H176–83.

    CAS  PubMed  Google Scholar 

  36. Aysin B, Aysin E. Effect of respiration in heart rate variability (HRV) analysis. Conf Proc IEEE Eng Med Biol Soc. 2006;1:1776–9. PubMed: 17946068.

    Article  PubMed  Google Scholar 

  37. Aysin B, Aysin E, Colombo J Comparison of HRV analysis methods during orthostatic challenge: HRV with respiration or without? IEEE Engineering in Medicine and Biology Conference. Lyons, France, 2007.

    Google Scholar 

  38. Low PA, Therapeutics and Technology Assessment Subcommittee. Assessment: clinical autonomic testing report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 1996;46:873–80.

    Google Scholar 

  39. Low PA, editor. Clinical autonomic disorders: evaluation and management. Philadelphia: Lippincott-Raven; 1997.

    Google Scholar 

  40. Malik M, editor. Clinical guide to cardiac autonomic tests. Dordrecht: Kluwer Academic Publishers; 1998.

    Google Scholar 

  41. Boulton AJM, Vinik AI, Arrezzo JC, Bril V, Feldman EI, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956–62.

    Article  PubMed  Google Scholar 

  42. Vinik A, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–97.

    Article  PubMed  Google Scholar 

  43. Bloomfield DM, Kaufman ES, Bigger Jr JT, Fleiss J, Rolnitzky L, Steinman R. Passive head-up tilt and actively standing up produce similar overall changes in autonomic balance. Am Heart J. 1997;134(2 Pt 1):316–20.

    Article  CAS  PubMed  Google Scholar 

  44. Vinik AI, Maser RE, Nakave AA. Diabetic cardiovascular autonomic nerve dysfunction. US Endocrine Disease. 2007.

    Google Scholar 

  45. Akinola A, Bleasdale-Barr K, Everall L, Mathias CJ. Investigation of autonomic disorders: appendix I. In: Mathias CJ, Bannister R, editors. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. London: Oxford Medical Publications; 1999.

    Google Scholar 

  46. American Academy of Physical Medicine and Rehabilitation. Correct coding initiative edits deleted for autonomic testing and therapy evaluations. CCI version 7.3, 1 Oct 2001, retroactive.

    Google Scholar 

  47. Roeltgen D, Bennett C. Automated Autonomic Nervous System Testing (ANSAR) has superior sensitivity compared to nerve conduction studies in the evaluation of small fiber peripheral neuropathy. Am Acad Neurosci. San Francisco, CA. 2004.

    Google Scholar 

  48. Gray MA, Rylander K, Harrison NA, Wallin BG, Critchley HD. Following one’s heart: cardiac rhythms gate central initiation of sympathetic reflexes. J Neurosci. 2009;29(6):1817–25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. McFarlane AC, Atchison M, Yehuda R. The acute stress response following motor vehicle accidents and its relation to PTSD. Ann N Y Acad Sci. 1997;821:437–41.

    Article  CAS  PubMed  Google Scholar 

  50. Watkins LR, Maier SF, Goehler LE. Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain. 1995;63(3):289–302.

    Article  CAS  PubMed  Google Scholar 

  51. Schneider GM, et al. Minimizing the source of nociception and its concurrent effect on sensory hypersensitivity: an exploratory study in chronic whiplash patients. BMC Musculoskelet Disord. 2010;11:29.

    Google Scholar 

  52. Curatolo ML, Arendt-Nielsen, Petersen-Felix S. Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury. Clin J Pain. 2004;20(6):469–76.

    Article  PubMed  Google Scholar 

  53. Scher AI, Stewart WF, Lieberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache. 1998;38:497–506.

    Article  CAS  PubMed  Google Scholar 

  54. Guitera V, Munoz P, Castillo J, Pascual J. Quality of life in chronic daily headache: a study in a general population. Neurology. 2002;9(58):1062–5.

    Article  Google Scholar 

  55. Abrams B. Update on managing chronic migraine. Published on-line at Pain.com. 2009.

  56. Headache classification committee, Olesen J, Bousser MG, Diener HC, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26(6):742–6.

    Article  CAS  PubMed  Google Scholar 

  57. Cady R. Ed Mayo Clin Proc. 2009;84(5):397–9.

    Article  Google Scholar 

  58. Lipton RB, Cady RK, Stewart WF, et al. Diagnostic lessons from the spectrum study. Neurology. 2002;58(9 suppl 6):S27–31.

    Article  CAS  PubMed  Google Scholar 

  59. Appel S, Kuritzky A, Zahavi I, Zigelman M, Akselrod S. Evidence for instability of the autonomic nervous system in patients with migraine headache. Headache. 1992;32(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  60. Zigelman M, Kuritzky A, Appel S, Davidovitch S, Zahavi I, Hering R, Akselrod S. Propranolol in the prophylaxis of migraine–evaluation by spectral analysis of beat-to-beat heart rate fluctuations. Headache. 1992;32(4):169–74.

    Article  CAS  PubMed  Google Scholar 

  61. Zigelman M, Appel S, Davidovitch S, Kuritzky A, Zahavi I, Akselrod S. The effect of verapamil calcium antagonist on autonomic imbalance in migraine: evaluation by spectral analysis of beat-to-beat heart rate fluctuations. Headache. 1994;34(10):569–77.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Autonomic Laboratory Department of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA

    Joseph Colombo PhD

  2. ANSAR Medical Technologies, Inc., Philadelphia, PA, USA

    Joseph Colombo PhD

  3. Department of Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  4. Department of Cardiology, The Chicago Medical School, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  5. Department of Cardiology, Hahnemann Hospital Drexel University College of Medicine, Philadelphia, PA, USA

    Nicholas L. DePace MD, FACC

  6. Department of Medicine, Eastern Virginia Medical School Strelitz Diabetes Research Center, Norfolk, VA, USA

    Aaron I. Vinik MD, PhD, FCP, MACP

Authors
  1. Joseph Colombo PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rohit Arora MD, FACC, FAHA, FACP, FSCAI
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas L. DePace MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aaron I. Vinik MD, PhD, FCP, MACP
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Colombo, J., Arora, R., DePace, N.L., Vinik, A.I. (2015). Pain Management. In: Clinical Autonomic Dysfunction. Springer, Cham. https://doi.org/10.1007/978-3-319-07371-2_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07371-2_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07370-5

  • Online ISBN: 978-3-319-07371-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation