The Impact of Autonomic Nervous System Modulation on Heart Rate Variability and Musculoskeletal Manifestations in Chronic Neck Pain: A Double-Blind Randomized Clinical Trial

Hani A Alkhawajah ¹

Ali M Alshami ²

Ali Albarrati ^{3, 4}

Department of Physiotherapy, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, P.O. Box 40244, Khobar 31952, Saudi Arabia |

Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam 31441, Saudi Arabia |

Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11451, Saudi Arabia |

⁴

King Salman Center for Disability Research, Riyadh 1164, Saudi Arabia |

Publication type: Journal Article

Publication date: 2024-12-30

MDPI

Journal: Journal of Clinical Medicine

scimago Q1

wos Q1

SJR: 0.882

CiteScore: 5.7

Impact factor: 3

ISSN: 20770383

DOI: 10.3390/jcm14010153

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Abstract

Background: The role of autonomic nervous system (ANS) modulation in chronic neck pain remains elusive. Transcutaneous vagus nerve stimulation (t-VNS) provides a novel, non-invasive means of potentially mitigating chronic neck pain. This study aimed to assess the effects of ANS modulation on heart rate variability (HRV), pain perception, and neck disability. Methods: In this double-blind randomized clinical trial, 102 participants with chronic neck pain were randomly allocated to one of three groups: t-VNS plus standard-care physiotherapy (SC-PT), heart rate variability biofeedback (HRV-BF) with SC-PT, or SC-PT alone. Interventions were administered three times weekly for 6 weeks. The following outcome measures were assessed at baseline and after 6 weeks: HRV, the visual analog scale (VAS), the pressure pain threshold (PPT), and the neck disability index (NDI). Results: The t-VNS group exhibited significant improvements compared to the HRV-BF and SC-PT groups. Specifically, t-VNS increased the RR interval (mean difference [MD] = 35.0 ms; p = 0.037) and decreased the average heart rate (MD = −5.4 bpm; p = 0.039). Additionally, t-VNS reduced the VAS scores (versus HRV-BF: MD = −0.8 cm, p = 0.044; SC-PT: MD = −0.9 cm, p = 0.018), increased the PPT (versus HRV-BF: MD = 94.4 kPa, p < 0.001; SC-PT (MD = 56.2 kPa, p = 0.001)), and lowered the NDI scores (versus HRV-BF: MD = −4.0, p = 0.015; SC-PT: MD = −5.9, p < 0.001). Conclusions: t-VNS demonstrated superior effectiveness compared to HRV-BF and SC-PT in regulating HRV, alleviating pain, and enhancing functional capabilities in individuals with chronic neck pain.