Studies on the nature of pain arising from an ischemic limb

Harpuder, Karl; Stein, Irwin D.

doi:10.1016/s0002-8703(43)90481-8

Cited by 26 publications

(3 citation statements)

References 29 publications

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“…In various musculoskeletal pain conditions such as the compartment syndrome the main cause of the deep tissue pain is related to reduced blood flow which compromises the metabolic demand under muscle work (Matsen, 1979; Martens et al, 1984; Martens and Moeyersoons, 1990). In experimental settings, repeated contractions of limb muscles under ischaemia by application of a tourniquet produce a deep pain sensation with moderate to high pain intensity (Harpuder and Stein, 1943; Lewis, 1932; Mills et al, 1982; Vecchiet et al, 1987).…”

Section: Introductionmentioning

confidence: 99%

Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline

Graven‐Nielsen

Jansson

Segerdahl

et al. 2003

European Journal of Pain

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Deep tissue pain can be related to reduced muscle blood flow, which comprises the metabolic demand under muscle work. The tissues and receptors involved in nociception after ischaemic muscle contractions are not known. The concentration of adenosine is increased after ischaemic contractions and might act as an algesic substance. In 15 subjects, adenosine, hypertonic saline (algesic), and isotonic mannitol (placebo) were infused into the tibialis anterior muscle and compared with the pain caused by ischaemic contractions. The muscle pain intensity (visual analogue scale; VAS), distribution, and quality were assessed. Pressure pain thresholds were recorded to assess the deep tissue sensitivity. Adenosine did not induce more pain than the placebo. The maximal VAS score after hypertonic saline and ischaemic contractions was higher compared with adenosine/placebo infusions. The duration and area of pain were significantly increased after hypertonic saline infusions compared with ischaemic contractions. Higher scores on the McGill pain questionnaire were given to the "stabbing", "burning", "heavy", and "exhausting" word categories after ischaemic contractions, and "cramping" was rated higher during hypertonic saline-induced muscle pain compared with ischaemic contractions. During hypertonic saline infusions, the pressure pain threshold was decreased compared with before and immediately after the pain had vanished. The present study shows that pharmacological levels of adenosine in skeletal muscle did not induce pain. Excitation of muscle nociceptors by hypertonic saline evoked hyperalgesia, larger areas of pain, and a different quality of pain compared with ischaemic contractions, suggesting that the pain after ischaemic contractions is mediated by other populations of nociceptors in muscle and/or other tissues than excited by hypertonic saline.

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Section: Introductionmentioning

confidence: 99%

Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline

Graven‐Nielsen

Jansson

Segerdahl

et al. 2003

European Journal of Pain

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“…Consequently, the aims of the present study were (1) to improve the temporal resolution of microdialysis measurements of [K + ] I to a level that would enable its role in the rapid physiological adjustments to exercise to be better studied, (2) to do so during dynamic exercise of different intensities, and (3) to contrast interstitial and arterial‐venous [K + ] during exercise. In addition, since it has been suggested that increases in [K + ] I might cause ischaemic muscle pain (Harpuder & Stein, 1943; Mense, 1993), we tested the hypothesis that the effect of ischaemia on muscle pain during exercise is associated with greater increases in [K + ] I .…”

mentioning

confidence: 99%

Interstitial and arterial‐venous [K⁺] in human calf muscle during dynamic exercise: effect of ischaemia and relation to muscle pain

Green

Langberg

Skovgaard

et al. 2000

The Journal of Physiology

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Changes in the concentration of interstitial K+ surrounding skeletal muscle fibres ([K+]I) probably play some role in the regulation of cardiovascular adjustments to muscular activity, as well as in the aetiology of muscle pain and fatigue during high‐intensity exercise. However, there is very little information on the response of [K+]I to exercise in human skeletal muscle. Five young healthy subjects performed plantar flexion exercise for four 5 min periods at increasing power outputs (≈1‐6 W) with 10 min intervening recovery periods, as well as for two 5 min periods with ischaemia at ≈1 and ≈3 W. Microdialysis probes were inserted into the gastrocnemius medialis muscle of the right leg to measure [K+]I, and K+ release from the plantar flexors during and after incremental exercise was calculated from plasma flow and arterial‐venous differences for K+. Calf muscle pain was assessed using a visual analogue scale. On average, [K+]I was 4.4 mmol l−1 at rest and increased during minutes 3‐5 of incremental exercise by ≈1‐7 mmol l−1 as a positive function of power output. K+ release also increased as a function of exercise intensity, although there was a progressive increase by ≈1‐6 mmol l−1 in the [K+] gradient between the interstitium and arterial‐venous plasma. [K+]I was lower during ischaemic exercise than control exercise. In contrast to this effect of ischaemia on [K+]I, muscle pain was relatively higher during ischaemic exercise, which demonstrates that factors other than changes in [K+]I are responsible for ischaemic muscle pain. In conclusion, this study has demonstrated that during 5 min of dynamic exercise, [K+]I increases during the later period of exercise as a positive function of exercise intensity, ischaemia reduces [K+]I during rest and exercise, and the increase in [K+]I is not responsible for muscle pain during ischaemic exercise.

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“…potassium, bradykinin, serotonin, prostaglandins, etc. (Harpuder & Stein 1943, Jensen & Norup 1992, Babenko et al. 1999).…”

Section: Discussionmentioning

confidence: 99%

Experimentally induced ischaemic pain in healthy humans is attenuated by the adenosine receptor antagonist theophylline

Segerdahl

Karelov

2004

Acta Physiologica Scandinavica

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Studies on the nature of pain arising from an ischemic limb

Cited by 26 publications

References 29 publications

Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline

Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline

Interstitial and arterial‐venous [K⁺] in human calf muscle during dynamic exercise: effect of ischaemia and relation to muscle pain

Experimentally induced ischaemic pain in healthy humans is attenuated by the adenosine receptor antagonist theophylline

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Studies on the nature of pain arising from an ischemic limb

Cited by 26 publications

References 29 publications

Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline

Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline

Interstitial and arterial‐venous [K+] in human calf muscle during dynamic exercise: effect of ischaemia and relation to muscle pain

Experimentally induced ischaemic pain in healthy humans is attenuated by the adenosine receptor antagonist theophylline

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Interstitial and arterial‐venous [K⁺] in human calf muscle during dynamic exercise: effect of ischaemia and relation to muscle pain