Non-pharmacological Intervention for Chronic Pain in Veterans: A Pilot Study of Heart Rate Variability Biofeedback.
Non-pharmacological Intervention for Chronic Pain in Veterans: A Pilot Study of Heart Rate Variability Biofeedback.
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DOI：
10.7453/gahmj.2013.075
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发表时间：
2014-03
影响因子：
--
通讯作者：
Nagpal ML
中科院分区：
文献类型：
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作者：
Berry ME;Chapple IT;Ginsberg JP;Gleichauf KJ;Meyer JA;Nagpal ML
慢性疼痛是一种使人情绪和身体衰弱的疼痛形式，它会激活身体的应激反应，随着时间的推移，会导致心率变异性（HRV）功率降低，这与恢复能力降低和自我调节能力降低有关。本试点项目旨在确定HRV一致性生物反馈（HRVCB）作为慢性疼痛退伍军人疼痛和压力管理干预的有效性，并估计其效应量。假设HRVCB会增加副交感神经活动，导致更高的HRV一致性测量为功率，并减少慢性疼痛患者自我报告的疼痛症状。14名接受慢性疼痛治疗的退伍军人参加了干预前和干预后的研究。他们是随机分配的，治疗组8名，对照组6名。治疗组采用生物反馈干预加标准治疗，另一组仅采用标准治疗。治疗组接受4次HRVCB培训作为干预。治疗组和对照组分别测量HRV振幅、HRV功率谱变量、心脏一致性以及感知疼痛、压力、负面情绪和身体活动限制的自我评定。使用自我评分的简短疼痛量表（BPI），所有受试者在基线时的平均疼痛严重程度为26.71 (SD=4.46；范围= 21-35)，表明研究对象的感知疼痛程度为中度至重度。治疗组和对照组在任何一项测量的基线上都没有显著差异。hrvcb后，治疗组的一致性显著高于对照组（P= 0.01），疼痛评分显著低于对照组（P= 0.02）。治疗组在一致性比（191%，P= 0.04）上显著且有统计学意义（单尾）增加，在疼痛评分（36%，P< 0.001）、压力感知（16%，P= 0.02）、负面情绪（49%，P< 0.001）和身体活动限制（42%，P< 0.001）上显著且有统计学意义（单尾）降低。当使用预训练值作为协变量时，发现所有测量结果都存在显著的组间效应。HRVCB干预可有效提高慢性疼痛退伍军人的HRV一致性（以LF波段上范围的功率衡量），减少感知疼痛、压力、负面情绪和身体活动限制。HRVCB有望成为一种有效的非药物干预手段，支持慢性疼痛的标准治疗。
Chronic pain is an emotionally and physically debilitating form of pain that activates the body's stress response and over time can result in lowered heart rate variability (HRV) power, which is associated with reduced resiliency and lower self-regulatory capacity. This pilot project was intended to determine the effectiveness of HRV coherence biofeedback (HRVCB) as a pain and stress management intervention for veterans with chronic pain and to estimate the effect sizes. It was hypothesized that HRVCB will increase parasympathetic activity resulting in higher HRV coherence measured as power and decrease self-reported pain symptoms in chronic pain patients. Fourteen veterans receiving treatment for chronic pain were enrolled in the pre-post intervention study. They were randomly assigned, with 8 subjects enrolled in the treatment group and 6 in the control group. The treatment group received biofeedback intervention plus standard care, and the other group received standard care only. The treatment group received four HRVCB training sessions as the intervention. Pre-post measurements of HRV amplitude, HRV power spectrum variables, cardiac coherence, and self-ratings of perceived pain, stress, negative emotions, and physical activity limitation were made for both treatment and control groups. The mean pain severity for all subjects at baseline, using the self-scored Brief Pain Inventory (BPI), was 26.71 (SD=4.46; range=21–35) indicating a moderate to severe perceived pain level across the study subjects. There was no significant difference between the treatment and control groups at baseline on any of the measures. Post-HRVCB, the treatment group was significantly higher on coherence (P=.01) and lower (P=.02) on pain ratings than the control group. The treatment group showed marked and statistically significant (1-tailed) increases over the baseline in coherence ratio (191%, P=.04) and marked, significant (1-tailed) reduction in pain ratings (36%, P<.001), stress perception (16%, P=.02), negative emotions (49%, P<.001), and physical activity limitation (42%, P<.001). Significant between-group effects on all measures were found when pre-training values were used as covariates. HRVCB intervention was effective in increasing HRV coherence measured as power in the upper range of the LF band and reduced perceived pain, stress, negative emotions, and physical activity limitation in veterans suffering from chronic pain. HRVCB shows promise as an effective non-pharmacological intervention to support standard treatments for chronic pain.