Heart rate variability in patients with low back pain: a systematic review

Scand J Pain. 2021 May 3;21(3):426-433. doi: 10.1515/sjpain-2021-0006. Print 2021 Jul 27.


Objectives: Heart rate variability (HRV) is an important physiological measure of the capacity for neurogenic homeostatic regulation, and an indirect measure of emotional processing. We aimed to investigate whether HRV parameters are altered in people with chronic low back pain when compared to healthy controls.

Methods: We searched on PubMed, Scopus, CINAHL, Web of Science, Cochrane Library, and PsycINFO from inception to January 2018. The inclusion criteria were: patients with non-specific chronic low back pain, absence of radiculopathy, age from 18 to 65 years, and comparison with healthy controls. Data extraction was performed by two independent review authors. The methodological quality of the studies was assessed using the appraisal tool for cross-sectional studies.

Results: After screening 2,873 potential articles, two studies met the inclusion criteria. Studies were composed of 153 patients with chronic low back pain and 62 healthy controls. An electrocardiogram was used to record HRV and linear methods (time and frequency) were used to analyze the results. The main findings indicate that patients with chronic low back pain have a significant reduction in HRV, with sympathetic predominance compared to healthy controls.

Conclusions: There is limited evidence suggesting that chronic low back pain patients presented a lower vagal activity evidenced by HRV, when compared to healthy controls. The results of this systematic review should be interpreted with caution due to the restricted number of included studies, small sample sizes and different protocols used to measure HRV. The limited evidence about HRV alterations in low back pain also suggests the need of future studies to investigate if HRV parameters can be a useful measure in chronic pain samples or even if it can be used as an outcome in clinical trials aiming to investigate the effectiveness of interventions based on emotion regulation.

Keywords: chronic pain; heart rate determination; low back pain; pain; systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chronic Pain*
  • Cross-Sectional Studies
  • Heart Rate
  • Humans
  • Low Back Pain*
  • Middle Aged
  • Young Adult