University of Oulu

Oura, P., Hautala, A., Kiviniemi, A. et al. Musculoskeletal pains and cardiovascular autonomic function in the general Northern Finnish population. BMC Musculoskelet Disord 20, 45 (2019) doi:10.1186/s12891-019-2426-2

Musculoskeletal pains and cardiovascular autonomic function in the general Northern Finnish population

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Author: Oura, Petteri1,2; Hautala, Arto3; Kiviniemi, Antti2,4;
Organizations: 1Faculty of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
2Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
3Faculty of Information Technology and Electrical Engineering, Center for Machine Vision and Signal Analysis, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
4Faculty of Medicine, Research Unit of Internal Medicine, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
5NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
6Finnish Institute of Occupational Health, Aapistie 1, FI-90220, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: Springer Nature, 2019
Publish Date: 2019-11-04


Background: Heart rate variability (HRV) and baroreflex sensitivity (BRS) measurements provide means for the objective assessment of cardiovascular autonomic function. As previous studies have associated chronic pain with abnormal autonomic function, we aimed to characterize the relationship between the number of musculoskeletal pain sites (NPS), pain intensity, and cardiovascular autonomic function among the population-based Northern Finland Birth Cohort 1966.

Methods: At the age of 46, cohort members self-reported their musculoskeletal pains (enabling the determination of NPS [0–8] and pain intensity [Numerical Rating Scale, NRS, 0–10]) and underwent clinical assessments of cardiovascular autonomic function in seated and standing positions (HRV variables: heart rate [HR] and root mean square of successive differences in beat-to-beat intervals [rMSSD] for the entire cohort; BRS variables: low-frequency systolic blood pressure variability [SBPV] and cross-spectral baroreflex sensitivity [BRS] for those attending the examination in Oulu, Finland). Extensive confounder data were also collected (body mass index, physical activity, smoking, Hopkins Symptom Checklist-25, comorbidities, and medications). The full samples included 4186 and 2031 individuals (HRV and BRS samples, respectively). Three subanalyses focused on individuals with intense and frequent pain, individuals with symptoms of depression and anxiety, and the relationship between pain intensity and autonomic parameters.

Results: Linear regression models showed varying associations between NPS, pain intensity, and cardiovascular autonomic parameters. However, after all adjustments NPS was only associated with one outcome among women (BRS, standing: beta = − 0.015, p = 0.048) and two among men (HR, seated: beta = − 0.902, p = 0.003; HR, standing: beta = − 0.843, p = 0.014). Pain intensity was not associated with any outcome after full adjustments. Significant sex*pain interactions were found in the data.

Conclusions: Our data suggest that musculoskeletal pain has, at most, a limited independent association with cardiovascular autonomic function. Future studies should carefully account for the potential confounders and sex interactions that this study revealed.

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Series: BMC musculoskeletal disorders
ISSN: 1471-2474
ISSN-E: 1471-2474
ISSN-L: 1471-2474
Volume: 20
Article number: 45
DOI: 10.1186/s12891-019-2426-2
Type of Publication: A1 Journal article – refereed
Field of Science: 3111 Biomedicine
3121 General medicine, internal medicine and other clinical medicine
Funding: The funds of Tekes – the Finnish Funding Agency for Technology and Innovation were received in support of this work. NFBC1966 received financial support from University of Oulu (Grant no. 24000692), Oulu University Hospital (Grant no. 24301140), and ERDF European Regional Development Fund (Grant no. 539/2010 A31592). A.K. received financial support from The Paulo Foundation (Espoo, Finland) and the Finnish Foundation for Cardiovascular Research (Helsinki, Finland). The funding sources had no involvement in study design, data collection, analysis, interpretation, or writing the paper.
Copyright information: © The Authors 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.