Heart rate variability as a biomarker of fibromyalgia syndrome

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread mechanical tenderness, fatigue, nonrefreshing sleep and depressed mood. Several biological abnormalities have been described in FM patients, including elevated substance P in the cerebrospinal fluid, increased CNS sensitivity to painful and nonpainful stimuli and pervasive dysfunction of the autonomic nervous system (ANS). Such ANS abnormalities include, but are not limited to: tachycardia, postural intolerance, Raynaud's phenomenon, and diarrhea or constipation. Heart rate variability (HRV) analysis of FM patients can be used to assess ANS dysfunction, specifically related to sympathovagal balance, which has provided evidence for nonabating sympathetic hyperactivity in this chronic pain population. Although not specific for FM, ANS dysfunction can be readily determined by HRV analysis requiring only computer analysis of electrocardiogram recordings by commercially available software. HRV has been shown to correlate with FM pain and is sensitive to change; in particular, pain related to physical and mental stressors. Thus, ANS dysfunction as assessed by HRV analysis may serve as a useful biomarker, and may become part of future FM diagnostic criteria and serve as a surrogate end point in clinical trials.