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Open Access Highly Accessed Research article

Heart rate variability in sciatica patients referred to spine surgery: a case control study

Jarmo Södervall12, Jaro Karppinen23, Jukka Puolitaival2, Eero Kyllönen2, Antti M Kiviniemi1, Mikko P Tulppo1 and Arto J Hautala1*

Author Affiliations

1 Department of Exercise and Medical Physiology, Verve Research, Kasarmintie 13, P.O. Box 404, Oulu, 90101, Finland

2 Department of Physical and Rehabilitation Medicine, Institute of Clinical Medicine, University of Oulu, Oulu, Finland

3 Finnish Institute of Occupational Health, Work and Health Ability, and Disability Prevention Centre, Oulu, Finland

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BMC Musculoskeletal Disorders 2013, 14:149  doi:10.1186/1471-2474-14-149

Published: 26 April 2013



A chronic pain condition may result in altered autonomic nervous system regulation in various patient populations. We evaluated whether autonomic regulation differs between sciatica patients referred to spine surgery and age-matched healthy controls analyzed with heart rate variability techniques (HRV).


HRV of patients (n = 201) and healthy controls (n = 138) were measured in standing conditions (5 min). High frequency (HF) power as an index of cardiac vagal modulation and the low-to-high-frequency (LF/HF) ratio and short-term fractal scaling exponent α1 as indices of sympathovagal balance were analyzed. Pain intensity was assessed on a Visual Analog Scale (VAS) and perceived disability with Oswestry Disability Index.


The Oswestry and VAS scores were higher in the patients than in the controls (p < 0.0001 for both). HF power was markedly lower for the patients compared to the controls (p < 0.0001). The LF/HF ratio and α1 were higher in the patients than in the controls (p < 0.01 for both). After adjusting for sex, smoking, BMI, and leisure-time physical activity, HF power (p = 0.011) and α1 (p = 0.012) still differed between the groups. Among the patients, HF power was slightly associated with the duration of chronic pain (r = −.232, p = 0.003).


Sciatica patients referred to spine surgery had altered cardiac autonomic regulation expressed as decreased vagal activity and an increased sympathovagal balance toward sympathetic dominance when compared with age-matched healthy controls.

Autonomic nervous system; Back pain; Sciatica; Sympathovagal balance; Vagal activity