Heart rate variability and pain sensitivity in people with chronic shoulder pain during passive viewing of shoulder movement pictures
6 affiliations
- 1Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, RibeirãoPreto, Brazil
- 2Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- 3Department of Physiotherapy, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil
- 4School of Physical and Occupational Therapy of McGill University, Montreal, Canada
- 5Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- 6Health Psychology, KU Leuven, Leuven, Belgium
Abstract
Background: Chronic shoulder pain involves interactions between emotional and autonomic processes that shape pain perception. Movement-related pictures may contribute to autonomic modulation imbalance in musculoskeletal pain. We compared the effects of viewing shoulder movement pictures on autonomic modulation and pressure pain threshold in chronic shoulder pain with pain-free controls. Methods: This was a cross-sectional study involving 56 chronic shoulder pain and 52 pain-free controls. Participants viewed a sequence of previously validated shoulder movement pictures. Heart rate variability, blood pressure variability, baroreflex sensitivity, pressure pain threshold, and self-reported pain intensity at rest and during the movement (using a numerical pain rating scale) were assessed before, during, and after shoulder movement pictures. Results: The chronic shoulder pain group showed a reduction in parasympathetic modulation compared to the pain-free control during (high frequency-HF: p = 0.04; variance: p = 0.00) and after shoulder movement pictures (HF: p = 0.03; variance: p = 0.01). The time x group interaction was not significant in low frequency (LF) or in the LF/HF ratio and blood pressure variability. The time x group interaction was significant in the baroreflex effectiveness index (p < 0.05). The pressure pain threshold was higher in the chronic shoulder pain group after the shoulder movement pictures, with a difference between groups (p < 0.001). Numerical pain rating scale did not change in chronic shoulder pain before and after shoulder movement pictures. Conclusion: Exposure to shoulder movement pictures resulted in reduced parasympathetic modulation and lower pressure pain threshold in chronic shoulder pain.
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BibTeX
@article{tozzo2026heart,
title = {{Heart rate variability and pain sensitivity in people with chronic shoulder pain during passive viewing of shoulder movement pictures}},
author = {Marcela C. Tozzo and Felipe J. J. Reis and Ann Meulders and Hugo C. D. de Souza and Naiara Chinellato and Ana Catarine Veiga and Anamaria S. de Oliveira},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0350902},
url = {https://doi.org/10.1371/journal.pone.0350902},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Heart rate variability and pain sensitivity in people with chronic shoulder pain during passive viewing of shoulder movement pictures
AU - Marcela C. Tozzo
AU - Felipe J. J. Reis
AU - Ann Meulders
AU - Hugo C. D. de Souza
AU - Naiara Chinellato
AU - Ana Catarine Veiga
AU - Anamaria S. de Oliveira
PY - 2026
DA - 2026/09/28
JO - PLOS One
DO - 10.1371/journal.pone.0350902
UR - https://doi.org/10.1371/journal.pone.0350902
AB - Background: Chronic shoulder pain involves interactions between emotional and autonomic processes that shape pain perception. Movement-related pictures may contribute to autonomic modulation imbalance in musculoskeletal pain. We compared the effects of viewing shoulder movement pictures on autonomic modulation and pressure pain threshold in chronic shoulder pain with pain-free controls. Methods: This was a cross-sectional study involving 56 chronic shoulder pain and 52 pain-free controls. Participants viewed a sequence of previously validated shoulder movement pictures. Heart rate variability, blood pressure variability, baroreflex sensitivity, pressure pain threshold, and self-reported pain intensity at rest and during the movement (using a numerical pain rating scale) were assessed before, during, and after shoulder movement pictures. Results: The chronic shoulder pain group showed a reduction in parasympathetic modulation compared to the pain-free control during (high frequency-HF: p = 0.04; variance: p = 0.00) and after shoulder movement pictures (HF: p = 0.03; variance: p = 0.01). The time x group interaction was not significant in low frequency (LF) or in the LF/HF ratio and blood pressure variability. The time x group interaction was significant in the baroreflex effectiveness index (p < 0.05). The pressure pain threshold was higher in the chronic shoulder pain group after the shoulder movement pictures, with a difference between groups (p < 0.001). Numerical pain rating scale did not change in chronic shoulder pain before and after shoulder movement pictures. Conclusion: Exposure to shoulder movement pictures resulted in reduced parasympathetic modulation and lower pressure pain threshold in chronic shoulder pain.
SN - 1932-6203
ER -