Volume loading hypoalgesia in SHR, WKY and F1 offspring of a SHR x WKY cross

Exploring the Association of Hypertension With Risk for Depression: Evidence for Tamed Neurobehavioral Arousal Versus Central Emotional Dysregulation

Depression is an established predictor of adverse cardiovascular disease outcomes. Less is known about cardiovascular risk factors as predictors of depression. In this issue of Psychosomatic Medicine (2018;80:508-514), Patel et al. report data indicating that pre-existing hypertension may be inversely associated with the atypical but not typical form of depression. We highlight here the strengths and limitations of the article and discuss the findings in light of research linking blood pressure and emotion regulation. In general, evidence suggests that higher blood pressure is associated with reduced expression of negative emotions and pain. Two prominent models of interaction have been proposed and supported by epidemiological and experimental research: one assumes that elevations in blood pressure lead to reduced arousal and pain sensitivity through baroreceptor activation and possibly additional afferent mechanisms. Operant conditioning may then result in (chronic) hypertension. The other one posits that impaired emotion processing as indicated by dampened emotion recognition may lead to disinhibition of hypothalamic centers and thereby result in sustained increases in blood pressure. These models are described in context of the current literature and open research questions are formulated.

Effects of arterial and cardiopulmonary baroreceptor activation on the upper limb nociceptive flexion reflex and electrocutaneous pain in humans

Attenuation of the lower limb nociceptive flexion reflex (NFR) during the cardiac cycle has been attributed to inhibition of sensorimotor function by arterial baroreceptor activation. It has been proposed that cardiopulmonary baroreceptors might have similar inhibitory effects. This study examined the effects of arterial and cardiopulmonary baroreceptor stimulation on nociceptive responding in the upper limb by delivering electrocutaneous stimuli to the ulnar nerve at 0, 150, 300, 450, or 600 ms after the R-wave of the electrocardiogram while participants lay supine with their legs raised or lowered. Nociceptive responding varied in a quadratic manner with phase of the cardiac cycle; responses were lowest at R+450 ms. Nociceptive responding and pain ratings did not differ between postures suggesting no cardiopulmonary effects. This phasic modulation of the upper limb withdrawal response provides further support for arterial baroreceptor-mediated inhibition of nociceptive transmission.

Effects of naltrexone on repressive coping and disclosure of emotional material: a test of the opioid-peptide hypothesis of repression and hypertension

OBJECTIVE

The present study was designed to assess the role of endogenous opioids in the relationship of hypertension to repressive coping.

METHODS

Ten hypertensive and 8 normotensive males were given either the opioid antagonist naltrexone or placebo in a randomized, double-blind fashion over the course of four laboratory sessions. Measures of repression and disclosure were completed and blood pressure was assessed during a laboratory stressor protocol.

RESULTS

Opioid antagonism reduced repression and increased disclosure only in the hypertensive group. Also, opioid antagonism increased stress-related systolic blood pressure only in the hypertensive group.

CONCLUSION

The results support the hypothesis that endogenous opioid dysregulation underlies both hypertension and repressive phenomena.

Volume expansion suppresses the tooth-pulp evoked jaw-opening reflex related activity of trigeminal neurons in rats

The aim of the present study is to clarify whether physiological stimulation of vagal afferents modulates the activity of the trigeminal spinal nucleus oralis (TSNO) neurons related to the tooth-pulp (TP)-evoked jaw-opening reflex (JOR) in pentobarbital-anesthetized rats. The activity of TSNO neurons and the amplitude of digastric electromyogram (dEMG) increased proportionally during 1.0-3.5 times the threshold for JOR. The amplitude of the dEMG of 14 out of 17 rats was suppressed by physiological stimulation of vagal afferents after intravenous infusion of Ficoll. Out of 23, 18 TSNO unit activities in 14 rats were also suppressed by Ficoll infusion. This suppressive effect of unit and dEMG activities returned to the control level within 25 min. After administration of naloxone (0.5 and 1.0 mg/kg, i.v.) the suppressive effect of Ficoll infusion on the activity of TSNO neurons (5/7) was significantly attenuated compared to the control (p < 0.01). The inhibition TSNO neuronal and dEMG activities by Ficoll infusion was volume-dependent in a range of 5-10% of total blood volume. Furthermore, right vagus nerve ligation greatly inhibited the suppressive effect of Ficoll-induced TSNO activity. These results therefore suggest that low-pressure cardiopulmonary baroreceptors whose afferents travel in the vagus nerve inhibit the pulpal nociceptive transmission.

Cardiopulmonary baroreflex stimulation and blood pressure-related hypoalgesia

Results from both experimental animals and humans suggest that baroreflex stimulation may be involved in blood pressure-related hypoalgesia. However, most of this research, especially in the area of human experimentation, has focused on sinoaortic baroreceptors. Cardiopulmonary baroreflex stimulation may also be an important moderator of pain. Sixty-six healthy male undergraduates varying in risk for hypertension participated in an experimental protocol in which painful mechanical finger pressure was presented three times in a counterbalanced fashion. One pain stimulus was preceded by 6 min of supine rest, another by a period of rest interspersed with periodic Valsalva manoeuvres, and another by a period in which cardiopulmonary baroreceptors were stimulated by passive leg elevation. Significantly lower pain was reported by men with relatively elevated systolic blood pressure following leg elevation but not the other conditions. Cardiopulmonary baroreflex stimulation was documented by increased forearm blood flow and other data obtained via impedance cardiography. These results suggest that blood pressure related hypoalgesia may be at least partially related to cardiopulmonary baroreflex stimulation.

Sympathetic nerve activity after acupuncture in humans

The aim of the present study was to determine if acupuncture stimulation inhibits sympathetic nerve activity in humans. Multiunit efferent postganglionic sympathetic activity was recorded with a tungsten microelectrode inserted in a muscle fascicle of the peroneal nerve. Mean arterial pressure, heart rate and skin blood flow were also monitored. Pain thresholds were measured by electrical tooth pain stimulation. After a 30 min rest, acupuncture needles were inserted bilaterally into the Li 11 and the Li 4 acupuncture points, and manipulated until 'chi' cramp-like sensation was reported. Electrical stimulation (2 Hz, 0.6-0.8 ms duration, maximal tolerated stimulation without discomfort) was delivered for 30 min and the physiological recordings were continued for 90 min after the end of acupuncture. In a placebo control experiment, the same procedure was followed, except that acupuncture needles were inserted subcutaneously and no manipulation or stimulation was given. The stimulator delivered pulses to an unconnected channel, hence, the same audiovisual stimuli were experienced as with acupuncture, and care was taken to ask the same questions about sensations in the placebo and the acupuncture groups. Electroacupuncture produced an increase in pain threshold which was paralleled by a transient increase in muscle sympathetic nerve activity. During acupuncture, there was a small increase in heart rate and mean arterial pressure, but there was no post-acupuncture hypotension. The placebo control procedure did not change pain threshold or sympathetic nerve traffic. The findings suggest that electroacupuncture produces moderate hypoalgesia in humans paralleled by a significant increase in muscle sympathetic nerve activity.

Hypertension-associated hypalgesia. Evidence in experimental animals and humans, pathophysiological mechanisms, and potential clinical consequences

A behavioral hypalgesia (increased response threshold to noxious stimuli) has been consistently, although not invariably, reported in spontaneous and experimental acute and chronic hypertension in the rat. Studies in human hypertension have also demonstrated a diminished perception of pain, assessed as pain thresholds or ratings. The sensitivity to painful stimuli correlated inversely with blood pressure levels, and this relationship extended into the normotensive range. Evidence in humans and rats points to a role of the baroreflex system in modulating nociception. In the rat, blood pressure-related antinociception may be due to attenuated transmission of noxious stimuli at the spinal level secondary to descending inhibitory influences that are projected from brain stem sites involved in cardiovascular regulation and that may depend on baroreceptor activation and/ or on a central "drive." Both endorphinergic and noradrenergic central neurons (the latter acting through postsynaptic alpha 2-receptors) have been shown to be involved, and other mediators probably also play a role. Functionally, blood pressure-related antinociception may represent an aspect of a more-complex coordinated adaptive response of the body to "stressful" situations. It is still uncertain whether in human essential hypertension hypalgesia is secondary to elevated blood pressure or whether both depend on some common mechanism. Studies on the effect of hypotensive treatment are too few to allow conclusions. According to one hypothesis, the reduction in pain perception caused by baroreceptor activation secondary to blood pressure elevation may represent a rewarding mechanism that may be reinforced with repeated stress and may be involved in the development of hypertension in some individuals. Hypertension-associated hypalgesia may have clinically relevant consequences, especially in silent myocardial ischemia and unrecognized myocardial infarction, both of which are more prevalent in hypertensive individuals.

Hypertension and objective and self-reported stressor exposure: a review

A review of the literature on the relationship between blood pressure and stressor exposure revealed a discrepancy between the results of studies based on objective measures of stressor exposure and studies based on self-reports. Whereas in the studies based on objective measures, a clear predominance of positive associations between blood pressure level and stressor exposure was found, in the studies based on self-reports, the results were highly inconsistent. Several moderator variables have been proposed that could explain the discrepancies found in the literature, such as awareness of hypertension and treatment. In studies in which these moderators were taken into account, inverse associations between blood pressure and self-reported stressor exposure have often been found. It is suggested that this result is brought about by altered appraisal of stressors in hypertensives.

Parental history of hypertension and enhanced cardiovascular reactivity are associated with decreased pain ratings

Ischemic pain was examined in adult males with and without a parental history of hypertension. Blood pressure and heart rate were recorded during baseline, cold pressor, and ischemia. Repeated pain ratings were obtained during cold pressor and ischemia, and the McGill Pain Questionnaire was completed after each stressor. A median split was used to identify high and low mean arterial pressure and heart rate reactors to cold pressor. Parental history of hypertension, high heart rate reactivity, and high mean arterial pressure reactivity were each associated with significantly lower ischemic pain ratings on the McGill Pain Questionnaire, suggesting that risk for hypertension is associated with hypoalgesia in normotensives.

Age, strain and anesthetic dependent differences in the nociceptive responses produced by i.v. 5-HT in the rat

The intravenous (i.v.) administration of serotonin (5-HT) to rats is a noxious visceral stimulus which produces distinct vagal afferent-mediated pseudaffective responses, a passive avoidance behavior, a vagal afferent-mediated inhibition of the tail-flick (TF) reflex and a complex cardiovascular response. In the present study, we examined the effects of age (10 or 16 weeks), strain (Sprague-Dawley, SD; Wistar-Kyoto, WKY; spontaneously hypertensive rats, SHR) and anesthetic (conscious or lightly pentobarbital-anesthetized) on nociceptive (TF reflex and pseudaffective responses) and cardiovascular responses produced by 5-HT (3-288 micrograms/kg, i.v.). There were no age-related differences in baseline TF latencies in the 3 strains. Further, latencies were generally not significantly different whether rats were tested conscious or lightly anesthetized. There were, however, strain differences. Both conscious or lightly pentobarbital-anesthetized SHR and WKY rats at 10 weeks of age had significantly faster response latencies than 10 week old SD rats. At 16 weeks of age, only the lightly pentobarbital-anesthetized WKY and SHR showed faster response latencies than SD rats. The WKY and SHR, but not the SD rats, were more sensitive to the nociceptive effect of i.v. 5-HT at 16 weeks of age compared to 10 weeks of age. At both ages, WKY and SHR, but not SD rats, showed an anesthetic-dependent increase in nociceptive sensitivity to i.v. 5-HT. In addition, at both ages, regardless of the presence of anesthetic, the order of sensitivity to the nociceptive effects of i.v. 5-HT was SD greater than WKY much much greater than SHR.(ABSTRACT TRUNCATED AT 250 WORDS)

Vagal afferent modulation of nociception

Chemical, electrical or physiological activation of cardiopulmonary vagal (cervical, thoracic or cardiac), diaphragmatic vagal (DVAG) or subdiaphragmatic vagal (SDVAG) afferents can result in either facilitation or inhibition of nociception in some species. In the rat, these effects depend upon vagal afferent input to the NTS and subsequent CNS relays, primarily in the NRM and ventral LC/SC, although specific relay nuclei vary as a function of the vagal challenge stimulus. Spinal pathways and neurotransmitters have been identified for vagally mediated effects on nociception and consistently implicate the involvement of descending 5-HT and noradrenergic systems, as well as intrinsic spinal opioid receptors. Species differences may exist with respect to both the effects of DVAG and SDVAG afferents on nociception and the efficacy of vagal afferents to modulate nociception. However, it is also possible that such differences reflect the modality of noxious input (e.g., visceral versus cutaneous), the type of neuronal activity investigated (e.g., resting versus noxious-evoked), spinal location of recording (e.g., thoracic versus lumbosacral) and/or parameters of stimulation. It is also possible that activation of some vagal afferents is aversive, but whether this contributes to changes in nociception produced by vagal activation has not clearly been established. Finally, the vagal-nociceptive networks described in this review provide a fertile area for future study. These networks can provide an understanding of physiological and pathophysiological peripheral events that affect nociception.

Reduced nociceptive effects of intravenous serotonin (5-HT) in the spontaneously hypertensive rat

This study compared the cutaneous (baseline tail-flick (TF) latencies) and visceral nociceptive responses (5-HT-induced inhibition of the TF reflex and pseudaffective responses) in lightly pentobarbital-anesthetized 16 week old Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). SHR were significantly less sensitive to the nociceptive effect of i.v. 5-HT compared to WKY rats. That is, SHR had a greater quantal ED50 for inhibition of the TF reflex than WKY rats (50.0 and 15.1 micrograms/kg, respectively). SHR also showed the presence of distinct pseudaffective responses (flattening of the ears, closure of the eyes to slits and contraction of the facial musculature) at much greater doses than in WKY rats, thereby paralleling the same changes in sensitivity observed the 5-HT-induced inhibition of the TF reflex. 5-HT-induced similar cardiovascular responses in WKY and SHR except that the SHR showed a significantly greater pressor response compared to WKY rats. These results demonstrate that the SHR show a marked reduction in sensitivity to the nociceptive, but not the cardiovascular, responses to i.v. 5-HT.

Vagal afferent-mediated inhibition of a nociceptive reflex by intravenous serotonin in the rat. I. Characterization

The effect of intravenous (i.v.) serotonin (5-HT) on nociception and blood pressure was examined in male Sprague-Dawley rats. Intravenous 5-HT produced a dose-dependent (6-192 micrograms/kg, i.v.) inhibition of the nociceptive tail-flick (TF) reflex in lightly pentobarbital-anesthetized (ED50 = 40 micrograms/kg) and conscious rats (ED50 = 44 micrograms/kg). In the lightly pentobarbital-anesthetized rat, the blood pressure response to i.v. 5-HT was typically a triphasic response with a marked Bezold-Jarisch reflex-induced decrease in pressure (associated with a brief period of apnea) followed by a pressor phase and a subsequent delayed hypotension. In the conscious rat, the response was typically biphasic with the late hypotensive phase absent. A variety of anatomical and pharmacological manipulations were performed to characterize the 5-HT-induced inhibition of the TF reflex and associated changes in blood pressure. Prevention of 5-HT-induced reflex apnea by artificial ventilation did not affect inhibition of the TF reflex produced by 5-HT. Pharmacological manipulations were performed to mimic, as closely as possible, the acute increases and decreases in blood pressure associated with i.v. 5-HT. Nitroprusside (8 micrograms/kg, i.v.) produced a decrease in blood pressure of similar magnitude and rate as that associated with the Bezold-Jarisch reflex-induced decrease in pressure produced by 72 micrograms/kg 5-HT, but did not change TF latency from baseline. Similarly, acute increases in pressure produced by phenylephrine (8 micrograms/kg, i.v.), intended to mimic the secondary pressor effect of 5-HT, did not change TF latency. The short-acting ganglion blocker trimethaphan (5 mg/kg, i.v.) closely mimicked the late hypotensive phase produced by 5-HT, but again resulted in no change in TF latency. Pretreatment with the ganglion blocker chlorisondamine (2.5 mg/kg) abolished all depressor responses to 72 micrograms/kg 5-HT, but did not significantly affect the TF reflex. These results indicate that acute changes in blood pressure and respiration associated with i.v. 5-HT do not contribute to inhibition of the TF reflex. This conclusion was confirmed in experiments in which bilateral vagotomy abolished approximately 70% of the 5-HT-induced inhibition of the TF reflex (and all depressor responses), and resulted in a significantly greater pressor response. Finally, low thoracic spinal cord transection (T9-10) abolished the inhibition of the TF reflex produced by i.v. 5-HT. Therefore, 5-HT stimulates vagal afferents and inhibits the TF reflex by activating descending inhibitory systems from the brainstem.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute increases in arterial blood pressure produced by occlusion of the abdominal aorta induces antinociception: peripheral and central substrates

Occlusion of the abdominal aorta proximal to the renal arteries results in an increase in arterial blood pressure, inhibition of forepaw and hindpaw withdrawal to a noxious mechanical stimulus, and inhibition of the tail-flick reflex to noxious heat. Occlusion of the abdominal aorta distal to the renal arteries does not elevate arterial blood pressure and produces no antinociceptive effects. Occlusion of the vena cava lowers arterial blood pressure and produces no antinociception. The inhibitory effects of occlusion of the abdominal aorta depend upon activation of high pressure baroreceptors since bilateral sinoaortic denervation, but not bilateral vagotomy, eliminates the inhibition with respect to all behavioral measures. The inhibitory effects with respect to the tail-flick reflex also depend upon activation of a descending inhibitory system since reversible cold block of the spinal cord at the level of the second thoracic vertebra eliminates the antinociception. This antinociception is also eliminated following intrathecal administration of the noradrenergic receptor antagonist phentolamine, but not by intrathecal administration of either methysergide or naloxone. These data support the view that activation of high pressure baroreceptors by increases in arterial blood pressure produces antinociception via activation of a spinopetal noradrenergic system.

Analgesic activity of morphiceptin, beta-casomorphin-4, and deltakephalin in normotensive Wistar-Glaxo and spontaneously hypertensive rats

The effects of intraventricular injection of beta-casomorphin-4, morphiceptin and deltakephalin (DTLET) on hot water tail flick and tail compression responses were investigated in Wistar Albino Glaxo (WAG) and spontaneously hypertensive rats (SHR). The effects of the mu agonist morphiceptin (20 nmol/rat), as assessed by the tail compression test, were significantly greater in SHR rats but did not differ between both strains when measured by tail flick latency. Opioid agonist deltakephalin (2 nmol/rat) in both tests elicited stronger analgesic effects in SHR as compared to WAG and these effects were blocked by naloxone in both tests used. beta-Casomorphin-4 exhibits moderate activity for mu receptors. In the tail flick test peptide (60 nmol/rat) produced an increase in latencies in SHR rats that was significantly greater than was observed in WAG rats. Naloxone pretreatment abolished the analgesic activity of beta-casomorphin-4 solely in the tail compression test in SHR. Analysis of the slopes of the dose-response curves seems to suggest that differences between the activity of these opioid peptides in SHR and WAG rats are based on a difference in the density and affinity of the subpopulation of the opioid receptors in these strains of rats.