ابعاد کنترل روانشناختی والدین: ارتباطات با پرخاشگری فیزیکی و رابطه پیش دبستانی در روسیه

Objective To examine health, psychological, and autonomic impairment differences between individuals with fibromyalgia and those with other chronic benign pain in these conditions. The possible role of the autonomic nervous system in the maintenance of chronic benign pain can be examined using heart rate variability (HRV), which measures the interplay between the excitatory sympathetic and the inhibitory parasympathetic nervous system. Predictors of HRV will also be examined. Methods This study examined resting HRV in a sample of 84 patients with chronic benign pain, a subgroup of whom had fibromyalgia. Participants completed a battery of self-report measures and underwent measurements of resting HRV. Results Individuals with fibromyalgia experienced higher levels of depression (t (82) = − 2.27, p < .05) and significantly greater difficulty with physical functioning (t (75.8) = 2.65, p < .01) than did those with other chronic benign pain, there were no significant differences in any of the HRV indices. Across all pain conditions, we found that age, gender, physical health functioning, pain anxiety, and pain sensations were all significant predictors of HRV, suggesting that each are involved in the relationship between chronic benign pain and autonomic function. Conclusions These findings emphasize the importance of addressing psychological distress and physical functioning in chronic pain populations and specifically fibromyalgia. Future research can further examine the role of physical health functioning, psychological distress, and pain severity in the relationship between chronic pain and autonomic abnormalities.

Chronic pain, defined as experiencing pain for at least 6 months that does not resolve with treatment, is a major health concern that accounts for 80% of physician visits [1]. A specific chronic pain condition is fibromyalgia, a condition of unexplained widespread pain with fatigue, sleep disturbances, gastrointestinal complaints, and psychological symptoms [2]. Although chronic pain generally has been associated with great morbidity [3], fibromyalgia has been associated with even more substantial health impairments [4] and [5]. For example, individuals with fibromyalgia exhibit increased emergency department utilization [6] and significantly worse mental health [7] compared to individuals with rheumatoid arthritis, suggesting that they may experience more severe physical and mental impairments compared to patients with other benign pain conditions. A growing body of research has begun to examine the possible role of the autonomic nervous system in the development and maintenance of chronic pain in general and fibromyalgia specifically [8]. A well established method of evaluating the state of the autonomic nervous system, that has been frequently used with individuals diagnosed with fibromyalgia [9] and [10], but less so with those diagnosed with other chronic benign pain is heart rate variability (HRV). HRV is a measure of the interplay between the excitatory sympathetic and the inhibitory parasympathetic nervous system [11]. The many indices of HRV can be used to examine autonomic abnormalities, with lower levels of resting HRV acting as a potential marker for deficits in self-regulation. Measures of HRV have been associated with different types of pain. For instance, patients with chronic low back pain exhibited reduced parasympathetic and increased sympathetic activity [12]. Likewise, patients with fibromyalgia exhibited significantly lower HRV [13], and increased sympathetic and decreased parasympathetic nervous system activity compared to a control group [13] and [14]. However, the emerging research on HRV in chronic pain conditions has several shortcomings. Mainly, the previous studies have not examined potential differences in autonomic function across different pain conditions. In addition, little attention has been paid to other factors that may be related to HRV function in individuals with pain conditions. For example, anxiety, depression, health impairments, and poor sleep were related to reduced HRV while active and acceptance coping were related to increased HRV across a number of studies and conditions [12], [15], [16], [17], [18] and [19]. Given the known association between chronic benign pain and many of these factors, examining the role of these psychosocial factors in autonomic function of individuals with chronic pain warrants further exploration. To our knowledge, no studies have compared HRV in individuals with fibromyalgia to those with other chronic benign pain conditions, nor have they explored psychosocial predictors of HRV indices in chronic benign pain. This study examines resting HRV in a sample of patients with chronic benign pain, a subgroup of whom had fibromyalgia. Our goals were to: 1) examine health, psychological, and HRV differences between individuals with fibromyalgia and those with other forms of chronic pain; and 2) identify predictors of HRV in individuals with chronic benign pain. We hypothesized that individuals with fibromyalgia had more severe symptoms across all examined domains, and that measures in each domain would be associated with autonomic nervous system functioning.