{"doi":"10.1093/pm/pnaf146","title":"Dynamic perioperative changes in baroreflex sensitivity predict postoperative pain","abstract":"OBJECTIVE: Although higher baroreflex sensitivity (BRS) is typically associated with reduced pain sensitivity, we previously reported that elevated preoperative BRS predicted greater postoperative pain after cardiothoracic surgery, a finding that challenges existing experimental evidence. This exploratory secondary analysis tested whether perioperative changes in BRS (ΔBRS) better predict postoperative pain severity. DESIGN: Exploratory secondary analysis of a prospective observational cohort. SUBJECTS: Seventy-two adults undergoing elective minimally invasive cardiothoracic surgery. METHODS: Spontaneous cardiovagal BRS was measured preoperatively (pain-free baseline) and on postoperative days (POD) 1 and 2 (during ongoing pain). Pain severity was assessed using the PEG scale. Inflammatory biomarkers (C-reactive protein, cytokines, albumin) were also measured. Multivariable regression models evaluated associations between BRS metrics and pain, adjusting for demographic, surgical, analgesic, and psychological covariates. RESULTS: Higher preoperative BRS was associated with greater postoperative BRS decline (ΔBRS) by POD2 (R2 = 0.12, P = 0.008) and with more severe pain on POD2 (R2 = 0.15, P = 0.003). ΔBRS was independently and inversely associated with pain severity (R2 = 0.09, P = 0.025) even after covariate adjustment. Although inflammatory markers increased postoperatively, they did not mediate these associations. CONCLUSIONS: Steep perioperative BRS declines, particularly among individuals with initially high values, may reflect autonomic destabilization and reduced baroreflex-mediated inhibition of nociception. These findings identify ΔBRS as a dynamic and mechanistically informative predictor of postoperative pain. Perioperative BRS monitoring could support individualized risk stratification and guide interventions aimed at stabilizing autonomic function to improve recovery outcomes.","journal":"Pain Medicine","year":2025,"id":578895,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9393,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1116168,"name":"Negmeldeen Mamoun","orcid":"0000-0003-4022-487X","position":1,"is_corresponding":false},{"id":413981,"name":"Andrey V. Bortsov","orcid":"0000-0002-6838-5854","position":2,"is_corresponding":false},{"id":286330,"name":"Joseph P. Mathew","orcid":"0000-0002-3815-4131","position":3,"is_corresponding":false},{"id":1116167,"name":"Heberto Suárez-Roca","orcid":"0000-0002-6448-1064","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-19T02:58:24.957414Z","pmid":"41129287","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}