Pre-surgical heart-rate variability strongly predicts less post-operative pain in patients with epilepsy

Laura Caton, Moreno Bolzon, Dario Boschiero, Julian F. Thayer, Yori Gidron

Research output: Contribution to journalArticlepeer-review


Objectives: Post-operative pain is a common clinical problem after surgery, yet its predictors are inconsistent and unclear. This study examined whether pre-surgical vagal cardiac efferent nerve activity, indirectly indexed by heart rate variability (HRV), predicts patients' pain after epileptic surgery. Methods: Using a prospective design, HRV was measured at rest during 5 min in n = 30 patients, prior to undergoing epileptic surgery. Post-operative pain was assessed every 8 h during the first 2 days after surgery, and our analyses focused on the worse pain level. We used multiple regression analyses and statistically considered several confounders (age, surgical duration, and analgesics during various surgical phases). Results: Multiple HRV indexes strongly and inversely predicted post-operative pain, with high-frequency HRV (HF-HRV) being the strongest predictor (r = −0.81, p < 0.001). In a hierarchical multiple regression, HF-HRV accounted for an additional and significant 18% of the variance in post-operative pain, after statistically considering effects of age, surgical duration and effects of two anaesthetics. Conclusions: Pre-surgical HF-HRV independently, strongly and inversely predicts post-operative pain. These results are in line with a neuromodulatory role of the vagus nerve in pain and have clinical implications for predicting and managing post-operative pain.

Original languageEnglish
Article number110421
JournalJournal of Psychosomatic Research
StatePublished - Jun 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.


  • Epilepsy
  • Heart rate variability (HRV)
  • Post-operative pain
  • Predictors
  • Surgery
  • Vagal nerve
  • Heart Rate
  • Prospective Studies
  • Humans
  • Vagus Nerve
  • Pain, Postoperative/diagnosis
  • Epilepsy/surgery

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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