Immediate Effect of Primal Reflex Release Technique on Heart Rate Variability in Chronic Neck Pain: A Case Report

Abstract

Primal reflex release technique (PRRT) is a paradigm shift in the treatment of pain which follows the principle of rebooting the autonomous nervous system (ANS), by down regulating the upgraded sympathetic component of ANS in a variety of pain syndromes. To check the effect of PRRT on chronic neck pain, a case study was done using Heart Rate Variability (HRV) and Visual Analogue Scale (VAS) as outcome measures. After conducting the one minute nociceptive exam for startle reflex, indication of the upgraded Sympathetic Nervous System (SNS), a single session of PRRT was carried out on a 24 year old female patient with chronic neck pain having a VAS score of 7 on activity and that of 5 on rest. Pre and post treatment HRV analysis was done using frequency domain and time domain parameters. Post PRRT treatment, an improvement in VAS scale with a score of 4 on activity and that of 3 on rest was seen. HRV showed a decrease in HFnu (26.7 vs 24.5), RMSSD (63.553 vs 59.216), SDNN (28.58 vs 34.82) and PNN50 (48.3 vs 42.5) which refers to decreased parasympathetic activity, and increased LFnu (73.3 vs 75.5) which indicates increased sympathetic activity. This was the first study evaluating the effect of PRRT with HRV. Further research needs to be conducted to validate HRV findings in chronic pain patients undergoing PRRT using a large sample size and interval based assessment of HRV. Key words: Neck Pain, Primal reflex release technique, Startle Reflex, Heart Rate Variability.