Does maladaptive cardiovagal modulation extend to gastric modulation in women with chronic pelvic pain?

• Published in: Neurourology and urodynamics Vol. 40; no. 1; pp. 193 - 200
• Main Authors: Williams, DeWayne, Muth, Eric, Thayer, Julian, Chelimsky, Thomas, Chelimsky, Gisela
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2021
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Chronic pain; Chronic Pain - physiopathology; chronic pelvic pain; Electrocardiography - methods; electrogastrography; Female; gastric myoelectrical activity; Heart rate; Heart Rate - physiology; heart rate variability; Humans; Middle Aged; Pelvic Pain - physiopathology; vagal modulation; Vagus nerve; Vagus Nerve - physiopathology; Young Adult; chronic pelvic pain; vagal modulation; electrogastrography; heart rate variability; gastric myoelectrical activity
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.24532

Background
Women with chronic pelvic pain (CPP) have poor cardiovagal modulation. It is unclear whether this finding reflects a broader abnormality across many systems such as gastro‐vagal modulation.
Aim
To determine if maladaptive cardiovagal activity in females with CPP is accompanied by maladaptive gastric myoelectric activity.
Methods
A total of 36 health controls (HC) and 75 CPP underwent supine (10 min), then upright (tilted 70° head up; 30 min), and back to supine (10 min) positions. High‐frequency heart rate variability (HF‐HRV; 0.15‐0.4 Hz) was measured as an index of cardiovagal activity. Cutaneous electrogastrography (EGG) assessed gastric myoelectric activity pre‐ and during‐upright tilt. EGG measures from 16 HC and 31 CPP patients were available for analysis and included relative percentage of gastric activity within the normal (2‐4 cpm) and tachygastria (4–10 cpm) ranges, plus ratio of normal/tachygastria.
Results
HF‐HRV was lower in CPP individuals at all time points (each p < .05). CPP individuals showed lesser decrease in HF‐HRV from supine to upright, and poorer HF‐HRV recovery from upright back to supine (F[1, 106] = 4.62, p = .034). HC showed increase in tachygastria activity (t[15] = −2.09, p = .054) while the CPP group showed no change in tachygastria activity from pre‐upright to upright (t[30] = −0.62, p = .537).
Conclusions
Individuals with CPP going from supine to upright demonstrate an impairment in both tachygastria and the parallel decrement in HRV. These results support the hypothesis of a generalized blunting in the physiological modulation in CPP individuals affecting both cardiovascular and gastric systems.