Psychophysiological responses to visceral and somatic pain in functional chest pain identify clinically relevant pain clusters

A D Farmer, S J Coen, M Kano, H Naqvi, P A Paine, S M Scott, P L Furlong, S L Lightman, C H Knowles, Q Aziz

Research output: Contribution to journalArticle (Academic Journal)

Abstract

BACKGROUND: Despite chronic pain being a feature of functional chest pain (FCP) its experience is variable. The factors responsible for this variability remain unresolved. We aimed to address these knowledge gaps, hypothesizing that the psychophysiological profiles of FCP patients will be distinct from healthy subjects.

METHODS: 20 Rome III defined FCP patients (nine males, mean age 38.7 years, range 28-59 years) and 20 healthy age-, sex-, and ethnicity-matched controls (nine males, mean 38.2 years, range 24-49) had anxiety, depression, and personality traits measured. Subjects had sympathetic and parasympathetic nervous system parameters measured at baseline and continuously thereafter. Subjects received standardized somatic (nail bed pressure) and visceral (esophageal balloon distension) stimuli to pain tolerance. Venous blood was sampled for cortisol at baseline, post somatic pain and post visceral pain.

KEY RESULTS: Patients had higher neuroticism, state and trait anxiety, and depression scores but lower extroversion scores vs controls (all p < 0.005). Patients tolerated less somatic (p < 0.0001) and visceral stimulus (p = 0.009) and had a higher cortisol at baseline, and following pain (all p < 0.001). At baseline, patients had a higher sympathetic tone (p = 0.04), whereas in response to pain they increased their parasympathetic tone (p ≤ 0.008). The amalgamating the data, we identified two psychophysiologically distinct 'pain clusters'. Patients were overrepresented in the cluster characterized by high neuroticism, trait anxiety, baseline cortisol, pain hypersensitivity, and parasympathetic response to pain (all p < 0.03).

CONCLUSIONS & INFERENCES: In future, such delineations in FCP populations may facilitate individualization of treatment based on psychophysiological profiling.

Original languageEnglish
Pages (from-to)139-48
Number of pages10
JournalNeurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society
Volume26
Issue number1
DOIs
Publication statusPublished - Jan 2014

Bibliographical note

© 2013 John Wiley & Sons Ltd.

Keywords

  • Adult
  • Chest Pain/diagnosis
  • Cluster Analysis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nociceptive Pain/diagnosis
  • Pain Measurement/methods
  • Psychophysiologic Disorders/diagnosis
  • Visceral Pain/diagnosis
  • Young Adult

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