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Previous research has examined the relationship between heart rate variability (<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>) and persistent pain. <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> is an index of autonomic nervous system functioning, and reflects the variability in time elapsed between heartbeats. Patients with chronic pain tend to exhibit lower <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>, which has been associated with poor adaptability, or psychological flexibility, to stress. The aim of the current study was to examine relationships between <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>, psychological flexibility, and pain in a sample of adolescents and young adults (<jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content>s) with <jats:styled-content style=\"fixed-case\">NF<\/jats:styled-content>1 and <jats:styled-content style=\"fixed-case\">PN<\/jats:styled-content>s. <jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content> participants (<jats:italic>n<\/jats:italic> = 40) 16 to 34 years of age with <jats:styled-content style=\"fixed-case\">NF<\/jats:styled-content>1 completed baseline measures of pain and psychological functioning, and underwent a 5\u2010minute electrocardiogram (<jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>). A subset of 20 participants completed follow\u2010up questionnaires and a second <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content> 8 weeks later. Spectral analyses of <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>s yielded a measure of high\u2010frequency heart rate variability (<jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>). Baseline correlations revealed that lower <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> is related to greater inflexibility and more pain interference, but not pain intensity. Moreover, psychological inflexibility significantly mediated the relationship between <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> and pain interference. Finally, regression models indicated that baseline psychological inflexibility is a significant predictor of <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> at follow\u2010up and, separately, that baseline <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> significantly predicted pain intensity at follow\u2010up. These findings suggest complex mind\u2013body processes in the experience of pain in <jats:styled-content style=\"fixed-case\">NF<\/jats:styled-content>1, which have not been studied previously. Implications for pain\u2010related interventions and future research are discussed.<\/jats:p>","DOI":"10.1111\/papr.12695","type":"journal-article","created":{"date-parts":[[2018,3,23]],"date-time":"2018-03-23T18:46:37Z","timestamp":1521830797000},"page":"969-978","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["The Relationship Between Heart Rate Variability, Psychological Flexibility, and Pain in Neurofibromatosis Type 1"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7661-1380","authenticated-orcid":false,"given":"Taryn M.","family":"Allen","sequence":"first","affiliation":[{"name":"Clinical Research Directorate\/Clinical Monitoring Research Program Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute Frederick Maryland U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari L.","family":"Struemph","sequence":"additional","affiliation":[{"name":"Health Psychology and Neurobehavioral Research Group National Cancer Institute Bethesda Maryland U.S.A"},{"name":"Pediatric Oncology Branch National Cancer Institute Bethesda Maryland U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Anne","family":"Toledo\u2010Tamula","sequence":"additional","affiliation":[{"name":"Clinical Research Directorate\/Clinical Monitoring Research Program Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute Frederick Maryland U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela L.","family":"Wolters","sequence":"additional","affiliation":[{"name":"Health Psychology and Neurobehavioral Research Group National Cancer Institute Bethesda Maryland U.S.A"},{"name":"Pediatric Oncology Branch National Cancer Institute Bethesda Maryland U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Baldwin","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Branch National Cancer Institute Bethesda Maryland U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Widemann","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Branch National Cancer Institute Bethesda Maryland U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Staci","family":"Martin","sequence":"additional","affiliation":[{"name":"Health Psychology and Neurobehavioral Research Group National Cancer Institute Bethesda Maryland U.S.A"},{"name":"Pediatric Oncology Branch National Cancer Institute Bethesda Maryland U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,4,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spen.2006.01.005"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.4"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/111.6.1355"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.6.1755"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.08.045"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2007.03.005"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.37123"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12399"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12480"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12160-009-9096-5"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2009.09.011"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10879-016-9328-5"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2010.05.001"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10484-011-9162-1"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(00)00338-4"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1037\/1089-2680.10.3.229"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsycho.2007.10.004"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.05.009"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000942"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2010.03.001"},{"key":"e_1_2_9_22_1","unstructured":"StumpfDA AlksneJF AnnegersJF et al.Neurofibromatosis conference statement. 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