199: Central Sensitization and Autonomic Function in Postsurgical Pain: A Report from the rTSA-PRO Cohort

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic postsurgical pain, Psychology, Assessment and Measurement of Pain/Nociception, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: Postsurgical pain is complex and heterogeneous, with individuals exhibiting variable postoperative responses across multidimensional recovery domains, including sensory and affective outcomes. Central nervous system mechanisms are increasingly recognized as contributors to persistent postsurgical pain, particularly through domains of heightened processing, such as central sensitization (CS), or systemic physiological stress, such as autonomic regulation. However, the distinct roles of CS and autonomic function in shaping multidimensional postsurgical pain trajectories remain unclear. Therefore, this study examined central sensitization symptoms and autonomic function, as indexed by HRV, in relation to preoperative pain phenotypes and early postoperative pain, affective symptoms, and sensory processing outcomes.

Methods: Participants undergoing reverse Total Shoulder Arthroplasty (rTSA) were recruited for a prospective, longitudinal cohort study, and completed baseline and 6-week postoperative assessments of pain symptoms (intensity [VAS]; central sensitization [CSI; Central Sensitization Inventory]; neuropathic pain [painDETECT]), autonomic function (HRV; quantified as RMSSD), affect (anxiety [GAD-7]; depression[PHQ-9]), and quantitative sensory testing (pressure pain thresholds [PPTs]; temporal summation [TS]) at surgical and control sites. HRV and CSI were examined as predictors of baseline and 6-week outcomes. Linear regression models, adjusted for age and sex, examined associations between baseline and pre-to-postoperative changes in HRV and CSI, and pain, affective, and sensory outcomes.

Results: At baseline, higher CSI was associated with more severe neuropathic pain symptoms (B=0.22, p=0.002) and TS at the unaffected deltoid (B=0.08, p=0.02). Clinically significant baseline CSI (total score ≥ 40) was also associated with higher baseline pain intensity ratings (B=2.64, p=0.05).
Higher baseline HRV predicted greater 6-week postoperative pain intensity (B=0.04, p=0.04) and anxiety symptoms (B=0.25, p=0.05).
Increased HRV from baseline to 6-weeks predicted more severe postoperative TS at the affected deltoid (B=0.19, p=0.05)., while increased CSI from baseline to 6-weeks predicted greater postoperative depression severity (B=0.10, p=0.04), but reduced TS at the affected deltoid (B=−0.06, p=0.03).

Conclusions: Elevated CS was associated with neuropathic pain and pain intensity, highlighting its potential utility for preoperative assessment. Unexpectedly, higher preoperative HRV predicted more severe postoperative pain and anxiety, and 6-week HRV increases were linked to amplified pain facilitation at the surgical site. Worsened CS pre-to-post-rTSA predicted more severe postoperative depression symptoms, but reduced surgical site pain facilitation. Many estimates were modest, limiting direct clinical impact or interpretation, but highlight preliminary pathways for exploring dynamic systemic changes. Overall, autonomic regulation and CS may reflect complex, context-dependent alterations in central pain processing and multidimensional recovery, rather than simple amplification or protective effects.

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Presenting Author: Cassie M. Argenbright, PhD
Submitting Author: Cassie Argenbright

Senior Author: Jason Zafereo, PT, PhD

IASP 2026 Global Year theme of Neuropathic Pain: No

• Cassie M. Argenbright: PhD - Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis TN
• Ian F. Scully: BS - Department of Psychology, The University of Texas at Arlington, Arlington TX
• My Nguyen - Department of Bioengineering, The University of Texas at Arlington, Arlington TX
• Robin B. Jarrett: PhD - Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas TX
• Khosrow Behbehani: PhD - Department of Bioengineering, The University of Texas at Arlington, Arlington TX
• Tracy L. Greer: PhD, MSCS - Department of Psychology, The University of Texas at Arlington, Arlington TX
• Jason Zafereo: PT, PhD - Department of Physical Therapy, The University of Texas Southwestern Medical Center, Dallas TX