Psychophysiological responses to visceral and somatic pain in functional chest pain identify clinically relevant pain clusters


Background: Despite chronic pain being a feature of functional chest pain (FCP) its experience is variable. The factors responsible for this variability remain unresolved. We aimed to address these knowledge gaps, hypothesizing that the psychophysiological profiles of FCP patients will be distinct from healthy subjects. Methods: 20 Rome III defined FCP patients (nine males, mean age 38.7 years, range 28-59 years) and 20 healthy age-, sex-, and ethnicity-matched controls (nine males, mean 38.2 years, range 24-49) had anxiety, depression, and personality traits measured. Subjects had sympathetic and parasympathetic nervous system parameters measured at baseline and continuously thereafter. Subjects received standardized somatic (nail bed pressure) and visceral (esophageal balloon distension) stimuli to pain tolerance. Venous blood was sampled for cortisol at baseline, post somatic pain and post visceral pain. Key Results: Patients had higher neuroticism, state and trait anxiety, and depression scores but lower extroversion scores vs controls (all p < 0.005). Patients tolerated less somatic (p < 0.0001) and visceral stimulus (p = 0.009) and had a higher cortisol at baseline, and following pain (all p < 0.001). At baseline, patients had a higher sympathetic tone (p = 0.04), whereas in response to pain they increased their parasympathetic tone (p ≤ 0.008). The amalgamating the data, we identified two psychophysiologically distinct 'pain clusters'. Patients were overrepresented in the cluster characterized by high neuroticism, trait anxiety, baseline cortisol, pain hypersensitivity, and parasympathetic response to pain (all p < 0.03). Conclusions & Inferences: In future, such delineations in FCP populations may facilitate individualization of treatment based on psychophysiological profiling.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences > Clinical and Systems Neuroscience
College of Health & Life Sciences > Aston Institute of Health & Neurodevelopment (AIHN)
College of Health & Life Sciences
Additional Information: This research/ADF was funded by a Medical Research Council project grant. QA was principal investigator for Medical Research Council grant no. MGAB1A1R. This is the peer reviewed version of the following article: Farmer, A. D., Coen, S. J., Kano, M., Naqvi, H., Paine, P. A., Scott, S. M., Furlong, P. L., Lightman, S. L., Knowles, C. H., & Aziz, Q. (2014). Psychophysiological responses to visceral and somatic pain in functional chest pain identify clinically relevant pain clusters. Neurogastroenterology and motility, 26(1), 139-148., which has been published in final form at This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Uncontrolled Keywords: Functional chest pain of presumed esophageal origin,pain clusters,pathophysiology,Endocrine and Autonomic Systems,Gastroenterology,Physiology
Publication ISSN: 1365-2982
Last Modified: 03 Jun 2024 07:15
Date Deposited: 20 Aug 2014 14:14
Full Text Link: http://onlineli ... .12245/abstract
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2013-12-13
Published Online Date: 2013-10-18
Authors: Farmer, A.D.
Coen, S.J.
Kano, M.
Naqvi, H.
Paine, P.A.
Scott, S.M.
Furlong, P.L. (ORCID Profile 0000-0002-9840-8586)
Lightman, S.L.
Knowles, C.H.
Aziz, Q



Version: Accepted Version

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