The Relationship between Heart Rate Variability, Psychological Flexibility, and Pain in Neurofibromatosis Type 1.

Author: Allen TM1, Struemph KL2,3, Toledo-Tamula MA1, Wolters PL2,3, Baldwin A3, Widemann B3, Martin S2,3
1Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, Maryland, 21702.
2Health Psychology and Neurobehavioral Research Group.
3Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, 20892-8200.
Conference/Journal: Pain Pract.
Date published: 2018 Mar 23
Other: Special Notes: doi: 10.1111/papr.12695. [Epub ahead of print] , Word Count: 252

Individuals with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PNs) can experience chronic pain. Previous research has examined the relationship between heart rate variability (HRV) and persistent pain. HRV is an index of autonomic nervous system functioning, and reflects the variability in time elapsed between heartbeats. Patients with chronic pain tend to exhibit lower HRV, which has been associated with poor adaptability, or psychological flexibility, to stress. The aim of the current study was to examine relationships between HRV, psychological flexibility and pain in a sample of adolescents and young adults (AYA) with NF1 and PNs. AYA participants (n=40) ages 16-34 years with NF1 completed baseline measures of pain, and psychological functioning, and underwent a 5-minute electrocardiogram (ECG). A subset of 20 participants completed follow-up questionnaires and a second ECG 8 weeks later. Spectral analyses of ECGs yielded a measure of high frequency HRV (HF-HRV). Baseline correlations revealed that lower HF-HRV is related to greater inflexibility and more pain interference, but not pain intensity. Moreover, psychological inflexibility significantly mediated the relationship between HF-HRV and pain interference. Finally, regression models indicated that baseline psychological inflexibility is a significant predictor of HF-HRV at follow-up and, separately, that baseline HF-HRV significantly predicted pain intensity at follow-up. These findings suggest complex mind-body processes in the experience of pain in NF1, which have not been studied previously. Implications for pain-related interventions and future research are discussed. This article is protected by copyright. All rights reserved.

KEYWORDS: Heart rate variability; adolescents/young adults; neurofibromatosis type 1; pain; psychological flexibility

PMID: 29570943 DOI: 10.1111/papr.12695