{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:58:55Z","timestamp":1790618335836,"version":"4.1.0"},"reference-count":82,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2023\/00513-0"],"award-info":[{"award-number":["2023\/00513-0"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["88887.928034\/2023-00"],"award-info":[{"award-number":["88887.928034\/2023-00"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic shoulder pain involves interactions between emotional and autonomic processes that shape pain perception. Movement-related pictures may contribute to autonomic modulation imbalance in musculoskeletal pain. We compared the effects of viewing shoulder movement pictures on autonomic modulation and pressure pain threshold in chronic shoulder pain with pain-free controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross-sectional study involving 56 chronic shoulder pain and 52 pain-free controls. Participants viewed a sequence of previously validated shoulder movement pictures. Heart rate variability, blood pressure variability, baroreflex sensitivity, pressure pain threshold, and self-reported pain intensity at rest and during the movement (using a numerical pain rating scale) were assessed before, during, and after shoulder movement pictures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The chronic shoulder pain group showed a reduction in parasympathetic modulation compared to the pain-free control during (high frequency-HF:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04; variance:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.00) and after shoulder movement pictures (HF:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03; variance:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). The time x group interaction was not significant in low frequency (LF) or in the LF\/HF ratio and blood pressure variability. The time x group interaction was significant in the baroreflex effectiveness index (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). The pressure pain threshold was higher in the chronic shoulder pain group after the shoulder movement pictures, with a difference between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Numerical pain rating scale did not change in chronic shoulder pain before and after shoulder movement pictures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exposure to shoulder movement pictures resulted in reduced parasympathetic modulation and lower pressure pain threshold in chronic shoulder pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0350902","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:36:30Z","timestamp":1790616990000},"page":"e0350902","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heart rate variability and pain sensitivity in people with chronic shoulder pain during passive viewing of shoulder movement pictures"],"prefix":"10.1371","volume":"21","author":[{"given":"Marcela C.","family":"Tozzo","sequence":"first","affiliation":[{"name":"Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo","place":["Ribeir\u00e3o, Preto, Brazil"],"department":["Department of Health Sciences"]},{"name":"Maastricht University","place":["Maastricht, The Netherlands"],"department":["Experimental Health Psychology, Faculty of Psychology and Neuroscience"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe J. J.","family":"Reis","sequence":"additional","affiliation":[{"name":"Federal Institute of Rio de Janeiro","place":["Rio de Janeiro, Brazil"],"department":["Department of Physiotherapy"]},{"name":"School of Physical and Occupational Therapy of McGill University","place":["Montreal, Canada"]},{"name":"Pain in Motion Research Group","place":["Brussels, Belgium"],"department":["Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4250-3928","authenticated-orcid":true,"given":"Ann","family":"Meulders","sequence":"additional","affiliation":[{"name":"Maastricht University","place":["Maastricht, The Netherlands"],"department":["Experimental Health Psychology, Faculty of Psychology and Neuroscience"]},{"name":"Health Psychology, KU Leuven","place":["Leuven, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo C. D.","family":"de Souza","sequence":"additional","affiliation":[{"name":"Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo","place":["Ribeir\u00e3o, Preto, Brazil"],"department":["Department of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiara","family":"Chinellato","sequence":"additional","affiliation":[{"name":"Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo","place":["Ribeir\u00e3o, Preto, Brazil"],"department":["Department of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Catarine","family":"Veiga","sequence":"additional","affiliation":[{"name":"Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo","place":["Ribeir\u00e3o, Preto, Brazil"],"department":["Department of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anamaria S.","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo","place":["Ribeir\u00e3o, Preto, Brazil"],"department":["Department of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"6","key":"pone.0350902.ref001","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1177\/0269215519831056","article-title":"The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: A systematic review","volume":"33","author":"L De Baets","year":"2019","journal-title":"Clin Rehabil"},{"issue":"1","key":"pone.0350902.ref002","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2519\/jospt.2017.7068","article-title":"Optimism moderates the influence of pain catastrophizing on shoulder pain outcome: A longitudinal analysis","volume":"47","author":"RA Coronado","year":"2017","journal-title":"J Orthop Sports Phys Ther"},{"issue":"12","key":"pone.0350902.ref003","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzae132","article-title":"\u201cI have faith in god that i will get better\u201d-the multidimensional perceptions and expectations of patients with chronic shoulder pain: A qualitative analysis of common sense","volume":"104","author":"LJ de Freitas","year":"2024","journal-title":"Phys Ther"},{"issue":"9","key":"pone.0350902.ref004","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1136\/bjsports-2017-098673","article-title":"Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: A systematic review","volume":"53","author":"A Luque-Suarez","year":"2019","journal-title":"Br J Sports Med"},{"key":"pone.0350902.ref005","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/j.jpain.2019.04.009","article-title":"Pain-related fear, pain intensity and function in individuals with chronic musculoskeletal pain: A systematic review and meta-analysis","author":"J Martinez-Calderon","year":"2019","journal-title":"J Pain"},{"issue":"1","key":"pone.0350902.ref006","doi-asserted-by":"crossref","DOI":"10.1097\/j.pain.0000000000003337","article-title":"Association between perception of harm and valence of shoulder movement images with disability levels related to chronic shoulder pain","volume":"166","author":"MC Tozzo","year":"2025","journal-title":"Pain"},{"issue":"1","key":"pone.0350902.ref007","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1186\/s12891-022-05973-8","article-title":"A systematic review of the global prevalence and incidence of shoulder pain","volume":"23","author":"J Lucas","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"issue":"2","key":"pone.0350902.ref008","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.neubiorev.2011.11.009","article-title":"A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health","volume":"36","author":"JF Thayer","year":"2012","journal-title":"Neurosci Biobehav Rev"},{"issue":"1","key":"pone.0350902.ref009","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.neuron.2020.05.024","article-title":"What is the relationship between pain and emotion? 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