CARDIOVASCULAR FUNCTIONAL-DISORDER AND STRESS AMONG PATIENTS HAVING NECK SHOULDER SYMPTOMS

Objectives-To investigate if autonomic nervous system function, reflec ted in cardiovascular variables, among patients with neck-shoulder sym ptoms (tension neck group (T)) differed from that in a symptom free co ntrol group (C), and to establish its relation with pain and psycholog ical stress. Methods-Twelve women with tension neck and nine controls in secretarial jobs were studied. They underwent an orthostatic test, deep breathing test, Valsalva manoeuvre, isometric handgrip test, and muscular endurance test. Pain was measured using visual analogue scale s, and psychological stress by the Modified Somatic Perception Questio nnaire (MSPQ). Plasma endothelin-1 (ET-1) was measured using high pres sure liquid chromatography and radioimmunoassay. Results-Signs of psyc hological stress were significantly (p < 0.001) more common in group T than in group C. Mean resting heart rate in group T (77.8 (SE 2.9) be ats/min; range 64-100) was significantly greater than that in group C (63.8 (3.1) beats/min; range 52-80) (p < 0.01). In the orthostatic tes t, the overall changes in R-R intervals during the first 40 heart beat s after standing up and during seven minutes of testing differed signi ficantly between the groups (p < 0.001, < 0.05, respectively). The inc rease in diastolic blood pressure in the three minute isometric handgr ip test was significantly less in group T (19.4 (3.5) mm Hg; range -5 to 35) than in group C (30 (3.4) mm Hg; range 15-50) (p < 0.05). The M SPQ score in the study group (n = 21) correlated positively with resti ng heart rate (r = 0.462, p < 0.05) and negatively with increase in di astolic blood pressure (r = -0.514, p < 0.05). Plasma concentrations o f ET-1 did not differ between the groups. Conclusion-Increased sympath etic activity was found among patients having neck-shoulder symptoms. Local mechanisms may have influenced the cardiovascular changes observ ed during isometric testing in these patients.