The Impact of Blood Pressure and Baroreflex Sensitivity on Wind-Up

Chung, Ok Yung; Bruehl, Stephen; Diedrich, Laura; Diedrich, André

doi:10.1213/ane.0b013e31817f8dfe

Cited by 57 publications

(76 citation statements)

References 46 publications

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“…In healthy individuals, elevated BP appears linked to reduced temporal summation to evoked pain stimuli in a manner paralleling findings for BP-related inhibition of responses to static evoked pain stimuli [15,24]. Limited work also suggests that chronic pain patients, in whom elevated temporal summation is typically observed, may exhibit altered associations between resting BP levels and degree of temporal summation [19]. In summary, chronic pain-related dysfunction in BP-related hypoalgesic mechanisms may reflect changes in both descending inhibitory and ascending facilitatory pain pathways.…”

Section: Introductionmentioning

confidence: 76%

“…The BP variables used in the analyses below reflected the mean of these four resting BP readings. Because previous studies have often shown little association between diastolic BP (DBP) and evoked pain measures [1,2,10,11,19,25], the results below focus on the influences of systolic BP (SBP). As expected, analyses for DBP paralleling those described below for SBP revealed no significant main or interaction effects involving DBP (all p > .23; results not detailed).…”

Section: Methodsmentioning

confidence: 99%

“…Although contributors to abnormal interactions between BP and pain modulatory systems in chronic pain patients are not well defined, some have suggested that chronic pain-related changes in descending inhibitory pathways (e.g., endogenous opioids, α 2 -adrenergic) and baroreflex sensitivity may be involved [17,18]. It is possible that upregulation of facilitatory ascending pain pathways (reflecting central sensitization) in chronic pain patients also might play a role [19].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, dynamic evoked pain measures, such as temporal summation of pain, are believed to reflect responsiveness of ascending pain facilitatory pathways that are often upregulated in chronic pain patients [19,20]. Temporal summation has been portrayed as an index of central sensitization [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Is Resolution of Chronic Pain Associated With Changes in Blood Pressure-related Hypoalgesia?

Coba

Bruehl

Garber

et al. 2018

Annals of Behavioral Medicine

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Background In healthy individuals, elevated resting blood pressure (BP) is associated with reduced pain responsiveness and lower temporal summation. Prior work indicates that this BP-related hypoalgesia is reduced in individuals with chronic pain. Purpose This study evaluated whether resolution of chronic pain was associated with greater BP-related hypoalgesia compared to nonresolution. Methods From a prospective sample of adolescents and young adults diagnosed with chronic functional abdominal pain an average of 9 years earlier, 99 individuals in whom the condition had resolved and 51 individuals with ongoing abdominal pain were studied. Resting systolic BP was assessed, followed by evaluation of thermal pain threshold and tolerance, and assessment of temporal summation to thermal pain stimuli. Results Higher resting systolic BP was significantly associated with higher pain threshold and tolerance, and lower temporal summation only in the group with resolved functional abdominal pain (p < .05). Hierarchical regressions revealed that interactions between BP and resolution of chronic pain were significant only for pain tolerance (p < .05). Analyses by sex indicated that interactions between BP and resolution status were significant for the temporal summation outcome in males but not in females.Conclusions Results suggest that BP-related hypoalgesic mechanisms may be more effective in individuals in whom chronic pain has resolved compared to those with ongoing chronic pain. Findings hint at sex differences in the extent to which resolution of chronic pain is associated with BP-related hypoalgesia. Whether greater BP-related hypoalgesia is a consequence of, or alternatively a contributor to, resolution of chronic pain warrants further investigation.

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Section: Introductionmentioning

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is Resolution of Chronic Pain Associated With Changes in Blood Pressure-related Hypoalgesia?

Coba

Bruehl

Garber

et al. 2018

Annals of Behavioral Medicine

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“…51 This might have evoked baroreflex-induced hypoalgesia 4,7 which, if anything, should have masked the expected pro-nociceptive effects of the drug treatment. Nevertheless, pro-nociceptive effects were detected after HFS in the M A N U S C R I P T…”

Section: Autonomic Activitymentioning

confidence: 99%

Involvement of Opioid Receptors and α2-Adrenoceptors in Inhibitory Pain Modulation Processes: A Double-Blind Placebo-Controlled Crossover Study

Hood

Drummond

2016

The Journal of Pain

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Accepted ManuscriptInvolvement of opioid receptors and α 2 -adrenoceptors in inhibitory pain modulation processes: a double-blind placebo-controlled crossover study This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 2 AbstractIn healthy humans, high-frequency electrical stimulation (HFS) of the forearm not only evokes local signs of central sensitization but also triggers broader ipsilateral inhibitory influences on pain akin to a lateralized form of conditioned pain modulation. Paradoxically, some of these inhibitory influences are augmented by α 2 -adrenoceptor blockade. To determine whether opioid peptides mediate inhibitory effects after HFS, the opioid receptor antagonist naltrexone was co-administered orally with the α 2 -adrenoceptor antagonist yohimbine in 16 healthy women in a double-blind placebo-controlled crossover study. In each session, mechanical sensitivity in the forearms and forehead was assessed before and after HFS. In addition, pain ratings to electrical stimulation of HFS-treated or control sites in the forearm were assessed during and after painful stimulation of each temple. Unlike yohimbine alone, the naltrexone + yohimbine combination blocked analgesia evoked by HFS in the ipsilateral forehead to blunt pressure, and opposed the ipsilateral inhibitory effect of pain in the temple on electrically-evoked pain at the HFS-treated site in the forearm. These findings imply involvement of opioid peptides in an ipsilateral analgesic response that complements the more generalized form of conditioned pain modulation. Opioid mediation of this ipsilateral analgesic response appears to override opposing α 2 -adrenoceptor effects.Perspective: HFS not only evokes local signs of central sensitization but also triggers a broader ipsilateral anti-nociceptive mechanism mediated by opioid receptors. Dysfunction of this lateralized pain modulation process might contribute to painful unilateral disorders such as migraine or complex regional pain syndrome.

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Sensory and pain modulation profiles of ongoing central neuropathic extremity pain in multiple sclerosis

Šrotová

Kočica

Vollert

et al. 2020

European Journal of Pain

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Background Central neuropathic extremity pain (CNEP) is the most frequent type of pain in multiple sclerosis (MS). The aim of the present study was to evaluate sensory and pain modulation profiles in MS patients with CNEP. Methods In a single‐centre observational study, a group of 56 CNEP MS patients was compared with 63 pain‐free MS patients and with a sex‐ and age‐adjusted control group. Standardized quantitative sensory testing (QST) and dynamic QST (dQST) protocols comprising temporal summation and conditioned pain modulation tests were used to compare sensory profiles. Results Loss‐type QST abnormalities in both thermal and mechanical QST modalities prevailed in both MS subgroups and correlated significantly with higher degree of disability expressed as Expanded Disability Status Scale (EDSS). Comparison of sensory phenotypes disclosed a higher frequency of the ‘sensory loss’ prototypic sensory phenotype in the CNEP subgroup (30%) compared with pain‐free MS patients (6%; p = .003). Conclusion The role of aging process and higher lesion load in the spinothalamocortical pathway might be possible explanation for pain development in this particular ‘deafferentation’ subtype of central neuropathic pain in MS. We were unable to support the role of central sensitization or endogenous facilitatory and inhibitory mechanisms in the development of CNEP in MS. Significance This article presents higher prevalence of the ‘sensory loss’ prototypic sensory phenotype in multiple sclerosis patients with central extremity neuropathic pain compared to pain‐free patients. Higher degree of disability underlines the possible role of higher lesion load in the somatosensory pathways in this particular ‘deafferentation’ type of central neuropathic pain.

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The Impact of Blood Pressure and Baroreflex Sensitivity on Wind-Up

Cited by 57 publications

References 46 publications

Is Resolution of Chronic Pain Associated With Changes in Blood Pressure-related Hypoalgesia?

Is Resolution of Chronic Pain Associated With Changes in Blood Pressure-related Hypoalgesia?

Involvement of Opioid Receptors and α2-Adrenoceptors in Inhibitory Pain Modulation Processes: A Double-Blind Placebo-Controlled Crossover Study

Sensory and pain modulation profiles of ongoing central neuropathic extremity pain in multiple sclerosis

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