The Relationship Between Blood Pressure and Pain

Abstract

The relationship between pain and hypertension is potentially of great pathophysiological and clinical interest, but is poorly understood. The perception of acute pain initially plays an adaptive role, which results in the prevention of tissue damage. The consequence of ascending nociception is the recruitment of segmental spinal reflexes through the physiological neuronal connections. In proportion to the magnitude and duration of the stimulus, these spinal reflexes cause the activation of the sympathetic nervous system, which increases peripheral resistances, heart rate, and stroke volume. The response also involves the neuroendocrine system, and, in particular, the hypothalamic‐pituitary‐adrenal axis, in addition to further activation of the sympathetic system by adrenal glands. However, in proportion to an elevation in resting blood pressure, there is a contemporary and progressive reduction in sensitivity to acute pain, which could result in a tendency to restore arousal levels in the presence of painful stimuli. The pathophysiological pattern is significantly different in the setting of chronic pain, in which the adaptive relationship between blood pressure and pain sensitivity is substantially reversed. The connection between acute or chronic pain and cardiovascular changes is supported observationally, but some of this indirect evidence is confirmed by experimental models and human studies. The pain regulatory process and functional interaction between cardiovascular and pain regulatory systems are briefly reviewed. Various data obtained are described, together with their potential clinical implications.

Fatores preditores de dor em idosos do Município de São Paulo, Brasil: Estudo SABE 2006 e 2010

“…Em relação à hipertensão arterial, sabe-se que os mecanismos de relação com a dor ainda não estão bem estabelecidos na literatura 22 . A presença de patologias crônicas associadas ao quadro álgico, embora seja um acontecimento comum no processo de envelhecimento, pode ser um fator que dificulta o tratamento.…”

“…Tal cenário pode dificultar a gestão do cuidado a esse paciente 24 . Vale destacar ainda que a dor crônica, em suas interações funcionais com o sistema cardiovascular, pode ser um fator preditor significativo do estado hipertensivo, independentemente da idade, raça, etnia ou hereditariedade 22 .…”

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“…The relationship between the cardiovascular and pain regulatory systems can be explained by the following: higher pain level perception is associated with raised ABP parameters [5,8,9,36,37].…”

“…As a result, changes in the heart rate (HR) and arterial blood pressure (ABP)-the systolic (SAP), diastolic (DAP) and median (MAP) parameters-can be registered [1][2][3][4]. The association between ABP and pain level is widely recognized, presenting a pattern that can be translated as-an increase in patient pain level perception corresponds to an increase in ABP values [5][6][7][8]. This relationship is the result of an interaction between the cardiovascular and nociceptive regulatory systems, mainly involving the neuroendocrine system.…”

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“…The stimulus to the nerve endings is produced by the release tissue and endothelial and platelet substances as a result of acute ischemia [48][49][50].…”