Autonomic Nervous System Dysregulation in People With Chronic Neck Pain

Autonomic Nervous System Dysregulation in People With Chronic Neck Pain - Indicated by Heart Rate Variability

The goal of this observational study is to investigate heart rate variability in different positions and in response to isometric hand-grip test in people with non-specific chronic neck pain as compared with healthy controls. The main questions it aims to answer are:

• Do the heart rate variability indices differ between people with non-specific chronic neck pain and healthy controls in supine sitting and standing positions?
• Do the heart rate variability indices differ between people with non-specific chronic neck pain and healthy controls when challenged by the isometric hand-grip test?

Study Overview

• Status: Completed
• Conditions: Chronic Neck Pain; Autonomic Nervous System
• Intervention / Treatment: Behavioral: Isometric hand grip test

Detailed Description

Background: Chronic neck pain (CNP) is a common symptom that affects the neck region with persistent or recurrent pain for more than 3 months. Ninety percent of people experience CNP is non-specific, meaning the underlying cause is not clear or specific. CNP is associated with risk factors that potentially induce sustained physiological responses. The autonomic nervous system (ANS) is responsible for controlling physiological functions and is required to adaptively respond to physical and mental stress. The risk factors may lead to ANS dysregulation and decrease capacity to cope with sensory and emotional stress. The ANS regulation can be measured through the assessment of heart rate variability (HRV). However, limited number of studies have documented the ANS dysregulation in people with CNP. The aim of present study is to investigate HRV in different positions and in response to isometric hand-grip (IHG) test in people with non-specific CNP as compared with healthy controls (HC).

Methods: This is an observational cross-sectional study. Twenty-eight participants with non-specific CNP and 28 age- and gender-matched HC will be recruited. The 5-min HRV and respiration rate will be measured for each condition including resting in supine, sitting and standing position, as well as the IHG test in supine, sitting and standing position. The 3-lead electrocardiography (ECG) data will be collected and analyzed for HRV indices, including time domain (mean R-R interval, standard deviation of the normal-to-normal interval and root mean square successive difference) and frequency domain (low frequency (LF), high frequency (HF) and LF/HF ratio). Statistical analysis: Descriptive data are presented as mean with standard deviation or frequency. Group differences in subject characteristics are analyzed using independent t-test or Chi-square test. Two-way mixed analyses of covariance (ANCOVAs) are used to assess HRV indices between groups and conditions with Tukey post hoc analysis. The maximal voluntary contraction of IHG test, pain intensity indicated by numeric rating scale and respiratory rate will be used as covariates. The significant level is set at p < 0.05.

• Study Type: Observational
• Enrollment (Actual): 56

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan, 112
    • National Yang-Ming University, Taiwan, R.O.C.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of healthy participants with or without chronic neck pain, recruited in Taipei.

Description

Chronic neck pain inclusion criteria:

• Chronic pain (persistent or recurrent pain >90 days)
• Non-specific chronic neck pain and non-irradiated to the upper limbs (Superior nuchal line ~ scapular spine ~ acromion)

Chronic neck pain & healthy control inclusion criteria:

• Age- and gender- matched (age: 20~59 y/o)
• BMI between 18.5~24.9 (Normal weight)
• Work at least 75% of full-time work

Exclusion criteria:

• Neurological diseases
• Orthopedic disorders
• Other disorders or regular use of medications known to affect physical activity, autonomic nervous system or pain perception

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Chronic neck pain; Individuals with non-specific chronic neck pain	Behavioral: Isometric hand grip test; The five-minute heart rate variability and respiration rate will be measured for each condition including resting in supine, sitting and standing position, as well as the isometric hand grip test in supine, sitting and standing position.
Healthy control; Individuals without non-specific chronic neck pain	Behavioral: Isometric hand grip test; The five-minute heart rate variability and respiration rate will be measured for each condition including resting in supine, sitting and standing position, as well as the isometric hand grip test in supine, sitting and standing position.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart rate variability	Time domain and frequency domain indices	Five-minute

Collaborators and Investigators

• Sponsor: National Yang Ming Chiao Tung University
• Investigators: Principal Investigator: Ray-Yau Wang, National Yang Ming Chiao Tung University

Study record dates

Study Major Dates

• Study Start (Actual): September 29, 2024
• Primary Completion (Actual): October 26, 2025
• Study Completion (Actual): October 27, 2025

Study Registration Dates

• First Submitted: August 12, 2024
• First Submitted That Met QC Criteria: August 12, 2024
• First Posted (Actual): August 15, 2024

Study Record Updates

• Last Update Posted (Actual): December 10, 2025
• Last Update Submitted That Met QC Criteria: December 9, 2025
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Posture; Heart rate variability; Isometric hand-grip test
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain
• Other Study ID Numbers: NYCU113077AE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No