Heart rate variability responses to cognitive stress in FM are characterised by inadequate autonomous system stress responses: 2023 Zetterman et al

Abstract

Fibromyalgia (FM) is associated with sympathetically dominant dysautonomia, but the connection between dysautonomia and FM symptoms is unclear. Dysautonomia can be analysed with heart rate variability (HRV) and it has been proposed that FM patients comprise subgroups with differing profiles of symptom severity.

In our study, 51 female FM patients aged 18 to 65 years and 31 age-matched healthy female controls followed a 20-min protocol of alternating relaxation and cognitive stress (mental arithmetic). Heart rates and electrocardiograms were registered. The HRV measures of heart rate (HR), mean interval between heart beats (RRmean), root mean squared interval differences of successive beats (RMSSD), and the standard deviation of intervals between normal heart beats (SDNN) were analysed with generalized linear modelling. Features in HRV reactivity which differed between FM patients and controls were used to cluster the FM patients and cluster characteristics were analysed.

FM patients had higher baseline HR (72.3 [SD 12.7] vs 64.5 [7.80], p < 0.001) and lower RRmean (0.844 [0.134] vs 0.934 [0.118], p = 0.002), compared with controls. They also reacted to repeated cognitive stress with an attenuated rise in HR (− 4.41 [95% CI − 7.88 to − 0.93], p = 0.013) and attenuated decrease of RRmean (0.06 [95 CI 0.03 to 0.09], p < 0.001), compared with controls.

Clustering of FM patients by HRV reactivity resulted in three clusters characterised by (1) normal levels of HRV and HRV reactivity with low levels of depressive mood and anxiety, (2) reduced levels of HRV and impaired HRV reactivity with increased levels of depressive mood and high levels of anxiety, and (3) lowest HRV and most impaired HRV reactivity with the highest scores for depressive mood and anxiety. Our results show that FM patients have lower HRV than healthy controls and their autonomous reactions to cognitive stress are attenuated. Dysautonomia in FM associates with mood disturbance.

Open access, https://www.nature.com/articles/s41598-023-27581-9

 

From the discussion section:

"Psychological symptoms are often involved in FM, as this and previous studies show, and pain treatment should include their management, with e.g., cognitive behavioural therapy intervention26. However, the findings about ANS function when comparing FM patients with healthy controls, and within FM patients in respect to anxiety and depression symptoms, raise the question of whether ANS dysfunction acts as a shared factor in both FM and psychological symptoms. This may provide a novel perspective for treatment. Identifying shared processes across pain conditions and comorbid problems is one primary objective in seeking improved pain treatment outcomes27. Decreased HRV is seen in both anxiety and depression and also in conjunction with worry at levels below the diagnosis of clinical anxiety disorder8,28."


No, actually what needs to be developed is a drug that decreases pain by at least 60% with tolerable side effects. And an understanding of what processes lead to the development and maintenance of FM, so it can be prevented, or stopped in its onslaught. Or attenuated (weakened).

 

They want the depression or anxiety to be the cause of the symptoms, though. They keep finding that it's a consequence, or actually should be viewed as a symptom, so they have to keep trying because their model says the opposite and the model is everything.

I keep seeing the same thing in LC, how the dysautonomia symptoms described as anxiety are not at all thought about physiological responses, they are just worry and mood, separate from the illness. It's *about* the illness, not the illness. Their entire worldview is constructed backward, so they have to turn reality upside down to make it make sense to them.

 

Exactly.

 

I really have to wonder if fibro predominately affected men instead of women, would there be so much research probing the role of moods in the disorder? Would men be subjected to terms like pain catastrophizing? Would it be as common to imply that the physical symptoms of fibro are a manifestation of personality disorders?

 

I think that back pain is about as common as fibromyalgia, though not always as disabling, and maybe wrong about that but I think it affects men more often.

Still psychologized. Same with Gulf War illness. They just say different things, but they mean the same. It's a universal mess.