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Bossenger NR, Lewis GN, Rice DA, Shepherd D. The autonomic and nociceptive response to acute experimental stress is impaired in people with knee osteoarthritis: A preliminary study. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 14:100144. [PMID: 38099282 PMCID: PMC10719531 DOI: 10.1016/j.ynpai.2023.100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 12/17/2023]
Abstract
Objective Alterations in autonomic function are evident in some chronic pain conditions but have not been thoroughly examined in people with osteoarthritis (OA). The study aimed to examine resting autonomic nervous system (ANS) function in people with knee OA, and the response of the autonomic and nociceptive systems to acute stress. Methods A preliminary cross-sectional study was undertaken involving people with knee OA (n = 14), fibromyalgia (n = 13), and pain-free controls (n = 15). The sympathetic and parasympathetic components of the ANS were assessed through measures of pre-ejection period (PEP), skin conductance level (SCL), and high frequency heart rate variability (HF HRV). The nociceptive system was assessed through pain ratings associated with a tonic heat pain stimulus. In separate sessions, ANS and heat pain measures were assessed at rest and in response to nociceptive and mental arithmetic stressors. Results The knee OA group showed reduced HF HRV at rest and reduced modulation in response to stress. Resting PEP and SCL were normal in the knee OA group but PEP modulation was impaired in both chronic pain groups during nociceptive stress. The expected reduction in tonic heat pain ratings in response to stress was lacking in the knee OA and FM groups. Conclusion Preliminary evidence shows impaired parasympathetic nervous system function at rest and in response to nociceptive and mental stress in people with knee OA, with some evidence of altered sympathetic nervous system function. Impaired ANS function could contribute to ongoing pain experienced, and interventions that target ANS function could be beneficial.
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Affiliation(s)
- Neil R Bossenger
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - David A Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Waitematā Pain Service, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Daniel Shepherd
- Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Sun GC, Tse J, Hsu YH, Ho CY, Tseng CJ, Cheng PW. μ-Opioid Receptor-Mediated AT1R-TLR4 Crosstalk Promotes Microglial Activation to Modulate Blood Pressure Control in the Central Nervous System. Antioxidants (Basel) 2021; 10:antiox10111784. [PMID: 34829655 PMCID: PMC8615018 DOI: 10.3390/antiox10111784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022] Open
Abstract
Opioids, a kind of peptide hormone involved in the development of hypertension, cause systemic and cerebral inflammation, and affects regions of the brain that are important for blood pressure (BP) control. A cause-and-effect relationship exists between hypertension and inflammation; however, the role of blood pressure in cerebral inflammation is not clear. Evidence showed that AT1R and μOR heterodimers’ formation in the NTS might lead to the progression of hypertension. In this study, we investigated the formation of the μOR/AT1R heterodimer, determined its correlation with μORs level in the NTS, and explored the role of TLR4-dependent inflammation in the development of hypertension. Results showed that Ang II increased superoxide and Iba-1 (microgliosis marker: ionized calcium-binding adaptor molecule (1) levels in the NTS of spontaneously hypertensive rats (SHRs). The AT1R II inhibitor, losartan, significantly decreased BP and abolished superoxide, Iba-1, TLR4 expression induced by Ang II. Furthermore, losartan significantly increased nNsOSS1416 phosphorylation. Administration of a μOR agonist or antagonist in the NTS of WKY and SHRs increased endogenous μ-opioids, triggered the formation of μOR/AT1R heterodimers and the TLR4-dependent inflammatory pathway, and attenuated the effect of depressor nitric oxide (NO). These results imply an important link between neurotoxicity and superoxides wherein abnormal increases in NTS endogenous μ-opioids promote the interaction between Ang II and μOR, the binding of Ang II to AT1R, and the activation of microglia. In addition, the interaction between Ang II and μOR enhanced the formation of the AT1R and μOR heterodimers, and inactivated nNOS-derived NO, leading to the development of progressive hypertension.
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Affiliation(s)
- Gwo-Ching Sun
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan;
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (J.T.); (Y.-H.H.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (C.-Y.H.); (C.-J.T.)
| | - Jockey Tse
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (J.T.); (Y.-H.H.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yung-Ho Hsu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (J.T.); (Y.-H.H.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chiu-Yi Ho
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (C.-Y.H.); (C.-J.T.)
- Department of Biomedical Science, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Ching-Jiunn Tseng
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (C.-Y.H.); (C.-J.T.)
- Department of Biomedical Science, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Pei-Wen Cheng
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (C.-Y.H.); (C.-J.T.)
- Department of Biomedical Science, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Correspondence: ; Tel.: +886-7-3422121 (ext. 71593); Fax: +886-7-3468056
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al'Absi M, Nakajima M, Bruehl S. Stress and pain: modality-specific opioid mediation of stress-induced analgesia. J Neural Transm (Vienna) 2021; 128:1397-1407. [PMID: 34405305 DOI: 10.1007/s00702-021-02401-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023]
Abstract
Preclinical research has demonstrated that exposure to acute stress is associated with attenuated pain perception, so called stress-induced analgesia (SIA). Mechanisms of SIA in humans have not been reliably demonstrated. This study examined the role of the endogenous opioid system in the impact of combined interpersonal and mental stressors on evoked pain responses in 84 participants (34 women). Using a within-subject, double-blinded, counterbalanced design, participants were administered either oral placebo or the opioid antagonist naltrexone (50 mg) across two testing sessions. In each session, they experienced two evoked pain stimuli (cold pressor test [CPT], heat pain) after an extended rest period (rest condition) and after exposure to an acute stressor (a combination of public speaking and mental arithmetic challenge; stress condition). Results showed that both stress and opioid blockade produced significant changes in hormonal and cardiovascular measures, consistent with successful induction of acute stress. Stress was associated with attenuated pain perception (SIA) as indicated by significantly increased CPT tolerance. These effects were particularly pronounced in individuals experiencing the stress condition first. More importantly, SIA effects on CPT tolerance were abolished by opioid blockade. There were no significant SIA effects on heat pain responses. This study demonstrates that the endogenous opioid system may mediate effects of acute stress on pain perception, although this effect seems to be qualified by the type of evoked pain stimuli experienced.
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Affiliation(s)
- Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, Minneapolis, MN, 55812, USA.
| | - Motohiro Nakajima
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, Minneapolis, MN, 55812, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract
OBJECTIVE Spontaneous or experimentally induced high blood pressure (BP) is associated with reduced pain perception, known as BP-related hypoalgesia. Despite its clinical implications, such as the interference with early detection of myocardial infarction in 'at risk' groups, the size of the association between high BP and pain has not yet been quantified. Moreover, the distinct association between high BP and physiological or psychological components of pain has not yet been considered so far. The aim of this study was to overcome this gap by performing separate meta-analyses on nociceptive response versus quantifiable perceptual measures of pain in relation to high BP. METHODS PubMed and Web of Knowledge databases were searched for English language studies conducted in humans. Fifty-nine studies were eligible for the analyses. Pooled effect sizes (Hedges' g) were compared. Random effect models were used. Results show that higher BP is significantly associated with lower nociceptive response (g = 0.38; k = 6) and reduced pain perception, assessed by quantifiable measures (g = 0.48; k = 59). RESULTS The association between BP and pain perception, derived from highly heterogeneous studies, was characterized by significant publication bias. BP assessment, pain assessment, site of pain stimulation, percentage of female participants in the sample, and control for potential confounders were significant moderators. CONCLUSION Current meta-analytic results confirm the presence of BP-related hypoalgesia and point towards the need for a better understanding of its underlying mechanisms.
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Ramaekers JG, Hutten N, Mason NL, Dolder P, Theunissen EL, Holze F, Liechti ME, Feilding A, Kuypers KPC. A low dose of lysergic acid diethylamide decreases pain perception in healthy volunteers. J Psychopharmacol 2021; 35:398-405. [PMID: 32842825 PMCID: PMC8054163 DOI: 10.1177/0269881120940937] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lysergic acid diethylamide (LSD) is an ergot alkaloid derivative with psychedelic properties that has been implicated in the management of persistent pain. Clinical studies in the 1960s and 1970s have demonstrated profound analgesic effects of full doses of LSD in terminally ill patients, but this line of research evaporated after LSD was scheduled worldwide. AIM The present clinical study is the first to revisit the potential of LSD as an analgesic, and at dose levels which are not expected to produce profound mind-altering effects. METHODS Twenty-four healthy volunteers received single doses of 5, 10 and 20 µg LSD as well as placebo on separate occasions. A Cold Pressor Test was administered at 1.5 and 5 h after treatment administration to assess pain tolerance to experimentally evoked pain. Ratings of dissociation and psychiatric symptoms as well as assessments of vital signs were included to monitor mental status as well as safety during treatments. RESULTS LSD 20 µg significantly increased the time that participants were able to tolerate exposure to cold (3°C) water and decreased their subjective levels of experienced pain and unpleasantness. LSD elevated mean blood pressure within the normal range and slightly increased ratings of dissociation, anxiety and somatization. CONCLUSION The present study provides evidence of a protracted analgesic effect of LSD at a dose that is low enough to avoid a psychedelic experience. The present data warrant further research into the analgesic effects of low doses of LSD in patient populations.
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Affiliation(s)
- Johannes G Ramaekers
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Nadia Hutten
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Natasha L Mason
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Patrick Dolder
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Eef L Theunissen
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Friederike Holze
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Kim PC Kuypers
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
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Hamam MS, Kunjummen E, Hussain MS, Nasereldin M, Bennett S, Miller J. Anxiety, Depression, and Pain: Considerations in the Treatment of Patients with Uncontrolled Hypertension. Curr Hypertens Rep 2020; 22:106. [PMID: 33170388 DOI: 10.1007/s11906-020-01117-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW The association between mental health, pain, and treatment-resistant hypertension is an important consideration for treating physicians. We review and discuss the connection between conditions of anxiety, depression, and chronic pain and their effect on uncontrolled hypertension. RECENT FINDINGS There is significant co-occurrence of hypertension with anxiety, depression, and chronic pain which may lead to undertreatment of hypertension and undertreatment of the underlying mental health disorder. The association between mental health and hypertension is complex and is modulated by physiologic and environmental factors. Physicians treating patients with hypertension should be cognizant of the role anxiety, depression, and chronic pain play in treatment efficacy and compliance. Patients undergoing treatment should be screened for mental health disorders at treatment initiation and frequently thereafter to ensure optimal overall health and compliance.
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Affiliation(s)
| | | | | | | | | | - Joseph Miller
- Henry Ford Hospital, Emergency Medicine, Detroit, MI, 48202, USA. .,Wayne State University, Detroit, MI, 48202, USA.
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Angiotensin II inhibits DDAH1-nNOS signaling via AT1R and μOR dimerization to modulate blood pressure control in the central nervous system. Clin Sci (Lond) 2019; 133:2401-2413. [PMID: 31755934 DOI: 10.1042/cs20191005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022]
Abstract
G protein-coupled receptors (GPCRs) are important drug targets. Blocking angiotensin II (Ang II) type 1 receptor signaling alleviates hypertension and improves outcomes in patients with heart failure. Changes in structure and trafficking of GPCR, and desensitization of GPCR signaling induce pathophysiological processes. We investigated whether Ang II, via induction of AT1R and μ-opioid receptor (μOR) dimerization in the nucleus tractus solitarius (NTS), leads to progressive hypertension. Ang II signaling increased μOR and adrenergic receptor α2A (α2A-AR) heterodimer levels and decreased expression of extracellular signal-regulated kinases 1/2T202/Y204, ribosomal protein S6 kinaseT359/S363, and nNOSS1416 phosphorylation. Dimethylarginine dimethylaminohydrolase 1 (DDAH1) expression was abolished in the NTS of adult spontaneously hypertensive rats (SHRs). Endomorphin-2 was overexpressed in NTS of adult SHRs compared with that in 6-week-old Wistar-Kyoto rats (WKY). Administration of μOR agonist into the NTS of WKY increased blood pressure (BP), decreased nitric oxide (NO) production, and decreased DDAH1 activity. μOR agonist significantly reduced the activity of DDAH1 and decreased neuronal NO synthase (nNOS) phosphorylation. The AT1R II inhibitor, losartan, significantly decreased BP and abolished AT1R-induced formation of AT1R and μOR, and α2A-AR and μOR, heterodimers. Losartan also significantly increased the levels of nNOSS1416 phosphorylation and DDAH1 expression. These results show that Ang II may induce expression of endomorphin-2 and abolished DDAH1 activity by enhancing the formation of AT1R and μOR heterodimers in the NTS, leading to progressive hypertension.
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de la Coba P, Bruehl S, Garber J, Smith CA, Walker LS. Is Resolution of Chronic Pain Associated With Changes in Blood Pressure-related Hypoalgesia? Ann Behav Med 2019; 52:552-559. [PMID: 29860365 DOI: 10.1093/abm/kax021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
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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Affiliation(s)
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Craig A Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Slepian PM, Ankawi B, France CR. Longitudinal Analysis Supports a Fear-Avoidance Model That Incorporates Pain Resilience Alongside Pain Catastrophizing. Ann Behav Med 2019; 54:335-345. [DOI: 10.1093/abm/kaz051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
The fear-avoidance model of chronic pain holds that individuals who catastrophize in response to injury are at risk for pain-related fear and avoidance behavior, and ultimately prolonged pain and disability.
Purpose
Based on the hypothesis that the predictive power of the fear-avoidance model would be enhanced by consideration of positive psychological constructs, the present study examined inclusion of pain resilience and self-efficacy in the model.
Methods
Men and women (N = 343) who experienced a recent episode of back pain were recruited in a longitudinal online survey study. Over a 3-month interval, participants repeated the Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, the McGill Pain Questionnaire, and NIH-recommended measures of pain, depressive symptoms, and physical dysfunction. Structural equation modeling assessed the combined contribution of pain resilience and pain catastrophizing to 3-month outcomes through the simultaneous combination of kinesiophobia and self-efficacy.
Results
An expanded fear-avoidance model that incorporated pain resilience and self-efficacy provided a good fit to the data, Χ2 (df = 14, N = 343) = 42.09, p = .0001, RMSEA = 0.076 (90% CI: 0.05, 0.10), CFI = 0.97, SRMR = 0.03, with higher levels of pain resilience associated with improved 3-month outcomes on measures of pain intensity, physical dysfunction, and depression symptoms.
Conclusions
This study supports the notion that the predictive power of the fear-avoidance model of pain is enhanced when individual differences in both pain-related vulnerability (e.g., catastrophizing) and pain-related protective resources (e.g., resilience) are considered.
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Affiliation(s)
| | - Brett Ankawi
- Department of Psychology, Ohio University, Athens, OH, USA
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Taking rejection to heart: Associations between blood pressure and sensitivity to social pain. Biol Psychol 2018; 139:87-95. [PMID: 30352273 DOI: 10.1016/j.biopsycho.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 01/06/2023]
Abstract
A reliable finding from the physical pain literature is that individuals with higher resting (i.e., tonic) blood pressure experience relatively less pain in response to nociceptive stimuli. Converging lines of evidence suggest that biological factors that influence the experience of physical pain may also relate to social pain. An open question, however, is whether higher blood pressure per se is a biological factor associated with lower sensitivity to social pain. This possible association was tested in three studies. Consistent with prior findings on physical pain, higher resting blood pressure was associated with lower self-reported sensitivity to social pain across individuals (Study 1 r = -.303, Study 2 r = -.262, -.246), even after adjusting for confounding factors related to blood pressure (Study 3 r = -.222). Findings suggest a previously unknown biological correlate of sensitivity to social pain, providing further evidence for possible shared substrates for physical and social pain.
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Blood pressure-related pain modulation in fibromyalgia: Differentiating between static versus dynamic pain indicators. Int J Psychophysiol 2018; 134:79-85. [PMID: 30321563 DOI: 10.1016/j.ijpsycho.2018.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/28/2018] [Accepted: 10/10/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Resting blood pressure (BP) has been found to be inversely associated with evoked pain responsiveness in healthy populations. However, some reports suggest that BP-related pain modulation may be dysfunctional in chronic pain patients. This study examined whether BP-related pain modulation, indexed by both static and dynamic evoked pain responses, is altered in fibromyalgia (FM) patients compared to pain-free individuals. METHOD Pain threshold and tolerance as static evoked pain measures and slowly repeated evoked pain (SREP) as a dynamic evoked pain index were measured in 30 FM patients and 27 healthy controls. BP was continuously recorded throughout a 5 minute pre-pain rest period. RESULTS SREP sensitization was observed only in the FM group. Higher BP predicted elevated pain threshold and tolerance in healthy individuals, but not in FM. Conversely, BP was inversely associated with SREP sensitization in FM whereas no association was found in healthy controls. CONCLUSIONS Static evoked pain measures suggested BP-related pain inhibitory dysfunction in FM. In contrast, for pain sensitization as indexed by SREP, FM displayed the expected BP-related inhibitory effects. BP-related pain modulation is manifested in FM differentially for static versus dynamic pain indicators. Use of both types of evoked pain measures may be valuable in the study of mechanisms underlying altered pain modulatory systems in FM.
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Abstract
OBJECTIVES Clinically feasible predictors of opioid analgesic responses for use in precision pain medicine protocols are needed. This study evaluated whether resting plasma β-endorphin (BE) levels predicted responses to an opioid analgesic, and whether chronic pain status or sex moderated these effects. METHODS Participants included 73 individuals with chronic low back pain (CLBP) and 88 pain-free controls, all using no daily opioid analgesics. Participants attended 2 identical laboratory sessions during which they received either intravenous morphine (0.08 mg/kg) or saline placebo, with blood samples obtained before drug administration to assay resting plasma BE levels. Once peak drug activity was achieved in each session, participants engaged in an ischemic forearm pain task (ISC) and a heat pain task. Morphine analgesic effects were derived reflecting the difference in pain outcomes between placebo and morphine conditions. RESULTS In hierarchical regressions, significant Type (CLBP vs. control)×BE interactions (Ps<0.05) were noted for morphine effects on ISC tolerance, ISC intratask pain ratings, and thermal VAS unpleasantness ratings. These interactions derived primarily from associations between higher BE levels and smaller morphine effects restricted to the CLBP subgroup. All other BE-related effects, including sex interactions, for predicting morphine analgesia failed to reach statistical significance. DISCUSSION BE was a predictor of morphine analgesia for only 3 out of 9 outcomes examined, with these effects moderated by chronic pain status but not sex. On the whole, results do not suggest that resting plasma BE levels are likely to be a clinically useful predictor of opioid analgesic responses.
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Characterization of a novel capsaicin/heat ongoing pain model. Eur J Pain 2017; 22:370-384. [DOI: 10.1002/ejp.1126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 12/27/2022]
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Siebenhuener K, Eschmann E, Kienast A, Schneider D, Minder CE, Saller R, Zimmerli L, Blaser J, Battegay E, Holzer BM. Chronic Pain: How Challenging Are DDIs in the Analgesic Treatment of Inpatients with Multiple Chronic Conditions? PLoS One 2017; 12:e0168987. [PMID: 28046033 PMCID: PMC5207693 DOI: 10.1371/journal.pone.0168987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 12/10/2016] [Indexed: 11/25/2022] Open
Abstract
Background Chronic pain is common in multimorbid patients. However, little is known about the implications of chronic pain and analgesic treatment on multimorbid patients. This study aimed to assess chronic pain therapy with regard to the interaction potential in a sample of inpatients with multiple chronic conditions. Methods and Findings We conducted a retrospective study with all multimorbid inpatients aged ≥18 years admitted to the Department of Internal Medicine of University Hospital Zurich in 2011 (n = 1,039 patients). Data were extracted from the electronic health records and reviewed. We identified 433 hospitalizations of patients with chronic pain and analyzed their combinations of chronic conditions (multimorbidity). We then classified all analgesic prescriptions according to the World Health Organization (WHO) analgesic ladder. Furthermore, we used a Swiss drug-drug interactions knowledge base to identify potential interactions between opioids and other drug classes, in particular coanalgesics and other concomitant drugs. Chronic pain was present in 38% of patients with multimorbidity. On average, patients with chronic pain were aged 65.7 years and had a mean number of 6.6 diagnoses. Hypertension was the most common chronic condition. Chronic back pain was the most common painful condition. Almost 90% of patients were exposed to polypharmacotherapy. Of the chronic pain patients, 71.1% received opioids for moderate to severe pain, 43.4% received coanalgesics. We identified 3,186 potential drug-drug interactions, with 17% classified between analgesics (without coanalgesics). Conclusions Analgesic drugs-related DDIs, in particular opioids, in multimorbid patients are often complex and difficult to assess by using DDI knowledge bases alone. Drug-multimorbidity interactions are not sufficiently investigated and understood. Today, the scientific literature is scarce for chronic pain in combination with multiple coexisting medical conditions and medication regimens. Our work may provide useful information to enable further investigations in multimorbidity research within the scope of potential interactions and chronic pain.
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Affiliation(s)
- Klarissa Siebenhuener
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
| | - Emmanuel Eschmann
- Research Center for Medical Informatics, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Kienast
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominik Schneider
- Maennedorf Hospital, Department of Internal Medicine, Canton Zurich, Switzerland
| | | | - Reinhard Saller
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- Institute of Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- Cantonal Hospital, Internal Medicine, Olten, Switzerland
| | - Jürg Blaser
- Research Center for Medical Informatics, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging,’ University of Zurich, Zurich, Switzerland
| | - Barbara M. Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- * E-mail:
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Horing B, McCubbin JA, Moore D, Muth ER. Resting blood pressure differentially predicts time course in a tonic pain experiment. Psychophysiology 2016; 53:1600-7. [PMID: 27424846 DOI: 10.1111/psyp.12724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/12/2016] [Indexed: 11/26/2022]
Abstract
Resting blood pressure (BP) shows a negative relationship with pain sensitivity (BP-related hypoalgesia). In chronic pain conditions, this relationship is inverted. The precise mechanisms responsible for the inversion are unknown. Using a tonic pain protocol, we report findings closely resembling this inversion in healthy participants. Resting BP and state measures of anxiety and mood were assessed from 33 participants (21 female). Participants then immersed their dominant hand in painfully hot water (47 °C) for five trials of 1-min duration, with 30-s intertrial intervals. Throughout the trials, participants continually registered their pain. After a 35-min intermission, the trial sequence was repeated. A disassociation of the negative relationship of resting systolic BP (as per Trial 1) was found using hierarchical linear modeling (p < .001, R(2) = .07). The disassociation unfolds over each consecutive trial, with an increasingly positive relationship. In Sequence 2, the initially negative relationship is almost completely absent. Furthermore, the association of BP and pain was found to be moderated by anxiety, such that only persons with low anxiety exhibited BP hypoalgesia. Our findings expand the existing literature by incorporating anxiety as a moderator of BP hypoalgesia. Furthermore, the protocol emulates the changing relationship between BP and pain observed in chronic pain patients. The protocol has potential as a model for chronic pain; however, future research should determine if similar physiological systems are involved. The finding holds potential diagnostic or prognostic relevance for certain clinical pain conditions, especially those involving dysfunction of the descending modulation of pain.
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Affiliation(s)
- Bjoern Horing
- Department of Psychology, Clemson University, Clemson, South Carolina, USA.
| | - James A McCubbin
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Dewayne Moore
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Eric R Muth
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
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16
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Davydov DM, Perlo S. Cardiovascular activity and chronic pain severity. Physiol Behav 2015; 152:203-16. [DOI: 10.1016/j.physbeh.2015.09.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/09/2015] [Accepted: 09/29/2015] [Indexed: 12/11/2022]
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17
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Sun GC, Ho WY, Chen BR, Cheng PW, Cheng WH, Hsu MC, Yeh TC, Hsiao M, Lu PJ, Tseng CJ. GPCR dimerization in brainstem nuclei contributes to the development of hypertension. Br J Pharmacol 2015; 172:2507-18. [PMID: 25573074 PMCID: PMC4409903 DOI: 10.1111/bph.13074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/20/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE μ-Opioid receptors, pro-opiomelanocortin and pro-enkephalin are highly expressed in the nucleus tractus solitarii (NTS) and μ receptor agonists given to the NTS dose-dependently increased BP. However, the molecular mechanisms of this process remain unclear. In vitro, μ receptors heterodimerize with α2A -adrenoceptors. We hypothesized that α2A -adrenoceptor agonists would lose their depressor effects when their receptors heterodimerize in the NTS with μ receptors. EXPERIMENTAL APPROACH We microinjected μ-opioid agonists and antagonists into the NTS of rats and measured changes in BP. Formation of μ receptor/α2A -adrenoceptor heterodimers was assessed with immunofluorescence and co-immunoprecipitation methods, along with proximity ligation assays. KEY RESULTS Immunofluorescence staining revealed colocalization of α2A -adrenoceptors and μ receptors in NTS neurons. Co-immunoprecipitation revealed interactions between α2A -adrenoceptors and μ receptors. In situ proximity ligation assays confirmed the presence of μ receptor/α2A -adrenoceptor heterodimers in the NTS. Higher levels of endogenous endomorphin-1 and μ receptor/α2A -adrenoceptor heterodimers were found in the NTS of hypertensive rats, than in normotensive rats. Microinjection of the μ receptor agonist [D-Ala(2) , MePhe(4) , Gly(5) -ol]-enkephalin (DAMGO), but not that of the α2A -adrenoceptor agonist guanfacine, into the NTS of normotensive rats increased μ receptor/α2A -adrenoceptor heterodimer formation and BP elevation. The NO-dependent BP-lowering effect of α2A -adrenoceptor agonists was blunted following increased formation of μ receptor/α2A -adrenoceptor heterodimers in the NTS of hypertensive rats and DAMGO-treated normotensive rats. CONCLUSIONS AND IMPLICATIONS Increases in endogenous μ receptor agonists in the NTS induced μ receptor/α2A -adrenoceptor heterodimer formation and reduced the NO-dependent depressor effect of α2A -adrenoceptor agonists. This process could contribute to the pathogenesis of hypertension.
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MESH Headings
- Adrenergic alpha-2 Receptor Agonists/administration & dosage
- Adrenergic alpha-2 Receptor Agonists/pharmacology
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/pharmacology
- Animals
- Blood Pressure/drug effects
- Brain Stem/drug effects
- Brain Stem/metabolism
- Dimerization
- Enkephalin, Ala(2)-MePhe(4)-Gly(5)-/administration & dosage
- Enkephalin, Ala(2)-MePhe(4)-Gly(5)-/pharmacology
- Hypertension/chemically induced
- Hypertension/metabolism
- Male
- Microinjections
- Narcotic Antagonists/administration & dosage
- Narcotic Antagonists/pharmacology
- Oligopeptides/metabolism
- Protein Multimerization
- Rats
- Rats, Inbred SHR
- Receptors, Adrenergic, alpha-2/metabolism
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/metabolism
- Solitary Nucleus/drug effects
- Solitary Nucleus/metabolism
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Affiliation(s)
- Gwo-Ching Sun
- Institute of Clinical Medicine, National Cheng-Kung UniversityTainan, Taiwan
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Medical Education and Research, Kaohsiung Veterans General HospitalKaohsiung, Taiwan
| | - Wen-Yu Ho
- Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Pharmacology, National Defense Medical CenterTaipei, Taiwan
| | - Bo-Rung Chen
- Department of Medical Education and Research, Kaohsiung Veterans General HospitalKaohsiung, Taiwan
| | - Pei-Wen Cheng
- Department of Medical Education and Research, Kaohsiung Veterans General HospitalKaohsiung, Taiwan
- Department of Pharmacology, National Defense Medical CenterTaipei, Taiwan
| | - Wen-Han Cheng
- Department of Medical Education and Research, Kaohsiung Veterans General HospitalKaohsiung, Taiwan
- Institute of Clinical Medicine, National Yang-Ming UniversityTaipei, Taiwan
| | - Mei-Chi Hsu
- Department of Nursing, I-Shou UniversityKaohsiung, Taiwan
| | - Tung-Chen Yeh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General HospitalKaohsiung, Taiwan
| | - Michael Hsiao
- Genomics Research Center, Academia SinicaTaipei, Taiwan
| | - Pei-Jung Lu
- Institute of Clinical Medicine, National Cheng-Kung UniversityTainan, Taiwan
| | - Ching-Jiunn Tseng
- Department of Medical Education and Research, Kaohsiung Veterans General HospitalKaohsiung, Taiwan
- Department of Pharmacology, National Defense Medical CenterTaipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming UniversityTaipei, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical UniversityTaichung, Taiwan
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18
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Heuch I, Heuch I, Hagen K, Zwart J. Does high blood pressure reduce the risk of chronic low back pain? The Nord-Trøndelag Health Study. Eur J Pain 2013; 18:590-8. [DOI: 10.1002/j.1532-2149.2013.00398.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 01/02/2023]
Affiliation(s)
- I. Heuch
- Department of Neurology and FORMI; Oslo University Hospital; Norway
| | - I. Heuch
- Department of Mathematics; University of Bergen; Norway
| | - K. Hagen
- Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
- Norwegian National Headache Centre; Department of Neurology; St. Olavs Hospital; Trondheim Norway
| | - J.A. Zwart
- Department of Neurology and FORMI; Oslo University Hospital; Norway
- Faculty of Medicine; University of Oslo; Norway
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19
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Bruehl S, Denton JS, Lonergan D, Koran ME, Chont M, Sobey C, Fernando S, Bush WS, Mishra P, Thornton-Wells TA. Associations between KCNJ6 (GIRK2) gene polymorphisms and pain-related phenotypes. Pain 2013; 154:2853-2859. [PMID: 23994450 DOI: 10.1016/j.pain.2013.08.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 01/25/2023]
Abstract
G-protein coupled inwardly rectifying potassium (GIRK) channels are effectors determining degree of analgesia experienced upon opioid receptor activation by endogenous and exogenous opioids. The impact of GIRK-related genetic variation on human pain responses has received little research attention. We used a tag single nucleotide polymorphism (SNP) approach to comprehensively examine pain-related effects of KCNJ3 (GIRK1) and KCNJ6 (GIRK2) gene variation. Forty-one KCNJ3 and 69 KCNJ6 tag SNPs were selected, capturing the known variability in each gene. The primary sample included 311 white patients undergoing total knee arthroplasty in whom postsurgical oral opioid analgesic medication order data were available. Primary sample findings were then replicated in an independent white sample of 63 healthy pain-free individuals and 75 individuals with chronic low back pain (CLBP) who provided data regarding laboratory acute pain responsiveness (ischemic task) and chronic pain intensity and unpleasantness (CLBP only). Univariate quantitative trait analyses in the primary sample revealed that 8 KCNJ6 SNPs were significantly associated with the medication order phenotype (P < .05); overall effects of the KCNJ6 gene (gene set-based analysis) just failed to reach significance (P = .054). No significant KCNJ3 effects were observed. A continuous GIRK Related Risk Score (GRRS) was derived in the primary sample to summarize each individual's number of KCNJ6 "pain risk" alleles. This GRRS was applied to the replication sample, which revealed significant associations (P < .05) between higher GRRS values and lower acute pain tolerance and higher CLBP intensity and unpleasantness. Results suggest further exploration of the impact of KCNJ6 genetic variation on pain outcomes is warranted.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA Center for Human Genetics Research, Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
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20
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Saccò M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M, Pioli S, Magnano A, Spagnoli F, Giuri PG, Fiaccadori E, Caiazza A. The relationship between blood pressure and pain. J Clin Hypertens (Greenwich) 2013; 15:600-5. [PMID: 23889724 PMCID: PMC8033897 DOI: 10.1111/jch.12145] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/17/2013] [Accepted: 04/24/2013] [Indexed: 02/05/2023]
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.
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Affiliation(s)
| | - Michele Meschi
- Nephro‐Cardiovascular Medicine and Hypertension CenterBorgo Val di Taro HospitalLocal Health AuthorityParmaItaly
| | - Giuseppe Regolisti
- Renal Failure UnitDepartment of Clinical and Experimental MedicineUniversity of ParmaParmaItaly
| | - Simona Detrenis
- Nephro‐Cardiovascular Medicine and Hypertension CenterBorgo Val di Taro HospitalLocal Health AuthorityParmaItaly
| | - Laura Bianchi
- Paediatric NephrologyParma Medical SchoolUniversity of ParmaParmaItaly
| | - Marcello Bertorelli
- Nephro‐Cardiovascular Medicine and Hypertension CenterBorgo Val di Taro HospitalLocal Health AuthorityParmaItaly
| | - Sarah Pioli
- Nephro‐Cardiovascular Medicine and Hypertension CenterBorgo Val di Taro HospitalLocal Health AuthorityParmaItaly
| | - Andrea Magnano
- Nephro‐Cardiovascular Medicine and Hypertension CenterBorgo Val di Taro HospitalLocal Health AuthorityParmaItaly
| | - Francesca Spagnoli
- Nephro‐Cardiovascular Medicine and Hypertension CenterBorgo Val di Taro HospitalLocal Health AuthorityParmaItaly
| | | | - Enrico Fiaccadori
- Renal Failure UnitDepartment of Clinical and Experimental MedicineUniversity of ParmaParmaItaly
| | - Alberto Caiazza
- Nephro‐Cardiovascular Medicine and Hypertension CenterBorgo Val di Taro HospitalLocal Health AuthorityParmaItaly
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21
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Olsen RB, Bruehl S, Nielsen CS, Rosseland LA, Eggen AE, Stubhaug A. Hypertension prevalence and diminished blood pressure-related hypoalgesia in individuals reporting chronic pain in a general population: the Tromsø study. Pain 2012; 154:257-262. [PMID: 23245863 DOI: 10.1016/j.pain.2012.10.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/21/2012] [Accepted: 10/29/2012] [Indexed: 11/29/2022]
Abstract
Resting blood pressure (BP) is inversely related to pain sensitivity in individuals free of chronic pain, reflecting homeostatic interactions between cardiovascular and pain modulatory systems. Several laboratory studies indicate that BP-related hypoalgesia is diminished in chronic pain patients, suggesting dysfunction in these interacting systems. Separate epidemiological findings reveal elevated hypertension prevalence in the chronic pain population. This study for the first time simultaneously evaluated both hypertension prevalence and BP-related hypoalgesia as they relate to chronic pain in the same sample. Resting BP and pain sensitivity were evaluated in a large general population sample (n=10,135, aged 30-87years). Subjects participated in a standardized 106s cold pressor test, providing pain ratings at 9s intervals. Self-reported presence of chronic pain and history of hypertension and use of antihypertensive medication were assessed. Significant interactions between chronic pain status and resting systolic (P<.001) and diastolic BP (P<.001) on mean pain ratings were observed. These interactions were due to significant (P<.001) BP-related hypoalgesia in individuals free of chronic pain that was twice the magnitude of the hypoalgesia observed in the group reporting chronic pain. Presence of chronic pain was associated with significantly increased odds of comorbid hypertension (P<.001). Within the chronic pain group, higher chronic pain intensity was a significant predictor of positive hypertension status beyond the effects of traditional demographic risk factors (P<.05). Results are consistent with the hypothesis that increased hypertension risk in the chronic pain population might be linked in part to chronic pain-related dysfunction in interacting cardiovascular-pain modulatory systems.
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Affiliation(s)
- Roy Bjørkholt Olsen
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway Faculty of Medicine, University of Oslo, Norway Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
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22
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King CD, Goodin B, Kindler LL, Caudle RM, Edwards RR, Gravenstein N, Riley JL, Fillingim RB. Reduction of conditioned pain modulation in humans by naltrexone: an exploratory study of the effects of pain catastrophizing. J Behav Med 2012; 36:315-27. [PMID: 22534819 DOI: 10.1007/s10865-012-9424-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 04/04/2012] [Indexed: 12/20/2022]
Abstract
The current study tested the hypothesis that conditioned pain modulation is mediated by the release of endogenous opioids with a placebo-controlled (sugar pill) study of naltrexone (50 mg) in 33 healthy volunteers over two counter-balanced sessions. Pain modulation consisted of rating of heat pain (palm) during concurrent cold water immersion (foot). Compared to baseline heat pain ratings, concurrent foot immersion lowered pain intensity ratings, which suggests an inhibitory effect, was reduced with naltrexone, suggesting at least partial dependence of inhibition on endogenous opioids. An exploratory analysis revealed that individual differences in catastrophizing moderated the effects of naltrexone; endogenous opioid blockade abolished modulation in subjects lower in catastrophizing while modulation was unaffected by naltrexone among high catastrophizers. The results suggest a role of endogenous opioids in endogenous analgesia, but hint that multiple systems might contribute to conditioned pain modulation, and that these systems might be differentially activated as a function of individual differences in responses to pain.
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Affiliation(s)
- Christopher D King
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, 1329 SW 16th St, Gainesville, FL 32610-3628, USA.
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23
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King JW, Bair E, Duggan D, Maixner W, Khan AA. The relationship between resting arterial blood pressure and acute postoperative pain in endodontic patients. JOURNAL OF OROFACIAL PAIN 2012; 26:321-327. [PMID: 23110272 PMCID: PMC4208728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIMS To evaluate the relationship between preoperative resting arterial blood pressure and postoperative pain in patients undergoing nonsurgical root canal therapy. METHODS Written informed consent was obtained from normotensive patients seeking treatment for teeth with a preoperative diagnosis of pulpal necrosis and periradicular periodontitis. Preoperative resting blood pressure was recorded, and nonsurgical root canal therapy was initiated using a standardized protocol. Patients recorded their pre- and postoperative pain intensity on a 100-mm visual analog scale (VAS) for 7 days after the procedure. A linear regression model to predict postoperative VAS intensity used preoperative pain and blood pressure values as covariates. Pearson correlations were calculated to assess the relationship between the measures of preoperative blood pressure and both pre- and postoperative pain. RESULTS After controlling for preoperative pain, significant correlations were observed between preoperative systolic blood pressure and postoperative pain (P < .05), as well as between preoperative pulse pressure and postoperative pain (P < .005) on day 1. CONCLUSION This study has provided further evidence of a functional interaction between the cardiovascular and trigeminal pain regulatory systems. Understanding this complex relationship may lead to enhanced pain management strategies.
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Affiliation(s)
| | | | | | | | - Asma A. Khan
- Correspondence: Asma A. Khan, BDS, PhD, 1170 Old Dental Building, CB #7450, University of North Carolina, Chapel Hill, NC 27599, Phone: (919) 966 2707, Fax: (919) 966 6344,
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24
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Abstract
This paper is the thirty-third consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2010 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
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25
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Haas K, Lu Q, Evans S, Tsao JC, Zeltzer LK. Relationship between resting blood pressure and laboratory-induced pain among healthy children. GENDER MEDICINE 2011; 8:388-98. [PMID: 22035675 PMCID: PMC3319441 DOI: 10.1016/j.genm.2011.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adult studies have demonstrated that increased resting blood pressure (BP) levels correlate with decreased pain sensitivity. However, few studies have examined the relationship between BP and experimental pain sensitivity among children. OBJECTIVES This study investigated the association between resting BP levels and experimental pain tolerance, intensity, and unpleasantness in healthy children. We also explored whether these BP-pain relationships were age and gender dependent. METHODS Participants underwent separate 4-trial blocks of cutaneous pressure and thermal pain stimuli, and 1 trial of a cold pain stimulus in counterbalanced order. RESULTS A total of 235 healthy children (49.6% female; mean age 12.7 [2.9] years; age range 8-18 years) participated. The study revealed specific gender-based BP-pain relationships. Girls with higher resting systolic BP levels were found to have lower thermal intensity ratings than girls with lower resting systolic BP levels; this relationship was stronger among adolescent girls than among younger girls. Among young girls (8-11 years), those with higher resting diastolic BP (DBP) levels were found to have lower cold intensity and unpleasantness as well as lower thermal intensity ratings than did young girls with lower resting DBP levels; these DBP-pain response relationships were not seen among adolescent girls. CONCLUSIONS Age, rather than resting BP, was predictive of laboratory pain ratings in boys. The findings suggest that the relationship between BP and experimental pain is age and gender dependent. These aspects of cardiovascular relationships to pain in males and females need further attention to understand their clinical importance.
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Affiliation(s)
- Kelly Haas
- University of California, Irvine School of Medicine, Irvine, California
- UCLA Pediatric Residency Program, University of California-Los Angeles, Los Angeles, California
| | - Qian Lu
- Department of Psychology, University of Houston, Houston, Texas
| | - Subhadra Evans
- Department of Psychology, University of Houston, Houston, Texas
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26
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Marques-Lopes J, Martins I, Pinho D, Morato M, Wilson SP, Albino-Teixeira A, Tavares I. Decrease in the expression of N-methyl-D-aspartate receptors in the nucleus tractus solitarii induces antinociception and increases blood pressure. J Neurosci Res 2011; 90:356-66. [PMID: 21948527 DOI: 10.1002/jnr.22760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/05/2011] [Accepted: 07/08/2011] [Indexed: 12/18/2022]
Abstract
N-methyl-D-aspartate receptors (NMDAR) have a role in cardiovascular control at the nucleus tractus solitarii (NTS), eliciting increases or decreases in blood pressure (BP), depending on the area injected with the agonists. In spite of the association between cardiovascular control and pain modulation, the effects of manipulating NMDAR in pain responses have never been evaluated. In this study, we decreased the expression of NMDAR in the NTS using gene transfer to target receptor subunits and evaluate long-term effects. Seven days after the injection of lentiviral vectors containing the NR1a subunit cDNA of NMDAR, in antisense orientation, into the intermediate NTS of Wistar rats, BP was measured, and the formalin test of nociception was performed. The antisense vector induced a decrease of NR1 expression in the NTS and elicited BP rises and hypoalgesia. Antisense vectors inhibited formalin-evoked c-Fos expression in the spinal cord, indicating decreased nociceptive activity of spinal neurons. Using a time-course approach, we verified that the onset of both the increases in BP and the hypoalgesia was at 4 days after vector injection into the NTS. The injection of NMDA into the NTS reversed the effects of antisense vectors in pain behavioral responses and spinal neuronal activation and decreased BP and heart rate. The present study shows that the NR1 subunit of the NMDAR at the NTS is critical in the regulation of tonic cardiovascular and nociceptive control and shows an involvement of the nucleus in the modulation of sustained pain.
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Affiliation(s)
- J Marques-Lopes
- Instituto de Farmacologia & Terapêutica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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