Autonomic Dysfunction, Psychosocial Factors, and Pain Sensitivity in Persistent Spinal Pain: A Systematic Review

Area of Science:

• Pain Medicine
• Neuroscience
• Musculoskeletal Health

Background:

• Persistent spinal pain (CLBP, chronic neck pain, WAD) is highly prevalent.
• Biopsychosocial framework highlights links between pain processing, psychological factors, and autonomic dysfunction.
• Concurrent relationships within these domains in chronic pain populations are poorly understood.

Purpose of the Study:

• To systematically evaluate associations among physiological autonomic measures, psychosocial scales, and pressure algometry in adults with persistent spinal pain.
• To clarify the interplay between autonomic function, psychological state, and pain sensitivity.

Main Methods:

• Systematic literature search across four databases (PubMed, Web of Science, Scopus, CINAHL) following PRISMA guidelines.
• Included studies assessing autonomic indices (e.g., HRV, BP), psychosocial factors (e.g., kinesiophobia, catastrophizing), and quantitative sensory testing (e.g., PPTs) within the same cohort.
• Narrative synthesis due to methodological heterogeneity; quality assessment using NIH tools.

Main Results:

• Six studies met eligibility criteria.
• Preliminary pattern: Objective functional outcomes and experimental pain processing associate more with autonomic proxies (e.g., HRV).
• Subjective clinical outcomes (e.g., perceived disability) link more consistently with psychosocial factors (e.g., kinesiophobia, catastrophizing).

Conclusions:

• Findings suggest distinct domain-specific associations rather than a uniform pain mechanism.
• Multimodal assessments are crucial for characterizing individual patient profiles in persistent spinal pain.
• Future research and practice should integrate physiological and psychological measures.