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Reyes Del Paso GA, Montoro CI, Daydov DM, Duschek S. The cardiac, vasomotor and myocardial branches of the baroreflex in hypotension: indications of reduced venous return to the heart. Clin Auton Res 2024:10.1007/s10286-024-01076-7. [PMID: 39417947 DOI: 10.1007/s10286-024-01076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024]
Abstract
PURPOSE Alterations of autonomic cardiovascular control are implicated in the origin of chronic low blood pressure (BP) (hypotension), but comprehensive analysis of baroreflex function is still lacking. This study explored baroreflex function in its cardiac, vascular and myocardial branches METHODS: Continuous BP was recorded at rest and during a mental arithmetic task in 40 hypotensive and 40 normotensive participants. Assessed cardiovascular variables included stroke volume (SV) (calculated by the Modelflow method), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and heart rate variability (HRV). Baroreflex sensitivity (BRS) was calculated using the spontaneous sequence method. RESULTS Hypotensive participants exhibited greater BRS in the three baroreflex branches, in addition to lower SV, HR and CO and higher HRV and TPR. Reactivity for BP, HRV and CO during the stress task was reduced in hypotensive individuals. The greater cardiac BRS can explain the lower HR and higher HRV observed in hypotension, suggestive of increased vagal cardiac influences. The higher vasomotor BRS may contribute to the greater TPR observed in the hypotensive participants. Abnormal associations between myocardial BRS and SV arose, suggesting aberrant autonomic control of myocardial contractility in hypotension. CONCLUSION The results indicate that hemodynamic deficits in hypotension are related to preload factors, probably triggered by hypovolemia and reduced unstressed blood reserves, resulting in lower venous return, ventricular preload and SV. In contrast, afterload mechanisms seem to work appropriately.
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Affiliation(s)
| | | | - Dmitry M Daydov
- Department of Psychology, University of Jaén, 23070, Jaén, Spain
| | - Stefan Duschek
- Institute of Psychology, UMIT Tirol-University of Health Sciences and Technology, Hall in Tirol, Austria
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Law KC, Anestis MD. Testing Whether Suicide Capability Has a Dynamic Propensity: The Role of Affect and Arousal on Momentary Fluctuations in Suicide Capability. Front Psychol 2021; 12:590187. [PMID: 34385942 PMCID: PMC8353180 DOI: 10.3389/fpsyg.2021.590187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
To prevent suicidal behaviors, it is crucial to understand the mechanisms and processes that enable an individual to act on suicidal thoughts. Suicide capability, which involves an increased pain tolerance and fearlessness of death, is a critical factor that enables an individual to endure the physical pain necessary to make a lethal suicide attempt. Extant research has largely conceptualized suicide capability as developing linearly in response to painful and provocative experiences, but the emerging literature on the temporal dynamics of suicide has been challenging the notion of linearity in suicide risk. Few studies have directly measured and compared changes in suicide capability in response to rumination on different affective states. We sought to experimentally test if rumination in the context of low vs. high arousal emotions will prompt distinct changes in two core components of suicide capability: pain tolerance and fearlessness of death on two undergraduate student samples. In both studies, participants provided measures of subjective emotional state as well as pain threshold, tolerance, and persistence before and after completing experimental manipulations which included both emotion and rumination induction procedures. In the second study, measures of fearlessness about death and physiological arousal (heart rate) were added to the experimental procedures. We found significant decreases in pain threshold, tolerance, and persistence following the experimental manipulations but found no main effects of rumination or suicide risk. These findings suggest that suicide capability can fluctuate but these changes may occur through a different mechanism and/or differ between individuals at varying levels of suicide risk.
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Affiliation(s)
- Keyne C Law
- Department of Clinical Psychology, School of Psychology, Family, and Community, Seattle Pacific University, Seattle, WA, United States
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, New Brunswick, NJ, United States.,Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ, United States
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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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Abstract
OBJECTIVE High blood pressure (BP) is associated with reduced pain sensitivity, known as BP-related hypoalgesia. The underlying neural mechanisms remain uncertain, yet arterial baroreceptor signaling, occurring at cardiac systole, is implicated. We examined normotensives using functional neuroimaging and pain stimulation during distinct phases of the cardiac cycle to test the hypothesized neural mediation of baroreceptor-induced attenuation of pain. METHODS Eighteen participants (10 women; 32.7 (6.5) years) underwent BP monitoring for 1 week at home, and individual pain thresholds were determined in the laboratory. Subsequently, participants were administered unpredictable painful and nonpainful electrocutaneous shocks (stimulus type), timed to occur either at systole or at diastole (cardiac phase) in an event-related design. After each trial, participants evaluated their subjective experience. RESULTS Subjective pain was lower for painful stimuli administered at systole compared with diastole, F(1, 2283) = 4.82, p = 0.03. Individuals with higher baseline BP demonstrated overall lower pain perception, F(1, 2164) = 10.47, p < .0001. Within the brain, painful stimulation activated somatosensory areas, prefrontal cortex, cingulate cortex, posterior insula, amygdala, and the thalamus. Stimuli delivered during systole (concurrent with baroreceptor discharge) activated areas associated with heightened parasympathetic drive. No stimulus type by cardiac phase interaction emerged except for a small cluster located in the right parietal cortex. CONCLUSIONS We confirm the negative associations between BP and pain, highlighting the antinociceptive impact of baroreceptor discharge. Neural substrates associated with baroreceptor/BP-related hypoalgesia include superior parietal lobule, precentral, and lingual gyrus, regions typically involved in the cognitive aspects of pain experience.
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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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Duschek S, Hoffmann A, Reyes Del Paso GA. Affective impairment in chronic low blood pressure. J Psychosom Res 2017; 93:33-40. [PMID: 28107890 DOI: 10.1016/j.jpsychores.2016.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/21/2016] [Accepted: 12/10/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Physical complaints such as faintness, dizziness, cold limbs and headaches have been well-established in chronic low blood pressure (hypotension). This study investigated the occurrence of adverse emotional states and the symptoms of depression in this condition. As autonomic dysregulation, particularly diminished sympathetic tone, is believed to be involved in the etiology of hypotension, the impact of different facets of autonomic cardiovascular control on mood and depressive symptoms was also explored. METHODS Forty individuals with chronic hypotension and forty normotensive control persons were presented with the Mood Scale and Beck Depression Inventory. Stroke volume, cardiac output, pre-ejection period, Heather index and aortic peak blood flow velocity were recorded under resting conditions as indices of beta-adrenergic inotropic drive. Respiratory sinus arrhythmia and baroreflex sensitivity were additionally obtained. RESULTS Hypotensive individuals scored markedly higher on both questionnaire scales than controls, indicating an adversely affected emotional state and more severe depressive symptoms. In the entire sample, cardiac output, Heather index, and aortic peak blood flow velocity correlated negatively with the questionnaire scores; according to regression analysis, the Heather index explained the largest proportion of test score variance. CONCLUSION Although hypotension does not constitute a serious medical condition, the findings of an adverse affective state and increased burden with depressive symptoms corroborate the view that it can have a considerable impact on wellbeing and quality of life. The correlations of the beta-adrenergic indices with the questionnaire scales indicate that cardiac sympathetic regulation plays a key role in the psychophysiological mediation of hypotension-related mood impairment.
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Affiliation(s)
- Stefan Duschek
- UMIT - University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Austria.
| | - Alexandra Hoffmann
- UMIT - University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Austria
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Scheuren R, Duschek S, Schulz A, Sütterlin S, Anton F. Blood pressure and the perception of illusive pain. Psychophysiology 2016; 53:1282-91. [DOI: 10.1111/psyp.12658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/11/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Raymonde Scheuren
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Duschek
- Institute of Psychology, UMIT-University for Health Sciences, Medical Informatics and Technology; Hall in Tirol Austria
| | - André Schulz
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Sütterlin
- Section of Psychology, Lillehammer University College; Lillehammer Norway
- Department of Psychosomatic Medicine, Division of Surgery and Clinical Neuroscience; Oslo University Hospital-Rikshospitalet; Oslo Norway
| | - Fernand Anton
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
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Jung YH, Shin JS, Lee J, Kim MR, Park KB, Choi A, Shin D, Ha IH. Influence of parity-related factors adjusted for abortion on knee osteoarthritis in Korean women aged 50 or older: A cross-sectional study. Maturitas 2015. [DOI: 10.1016/j.maturitas.2015.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bae YH, Shin JS, Lee J, Kim MR, Park KB, Cho JH, Ha IH. Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study. PLoS One 2015; 10:e0138790. [PMID: 26393797 PMCID: PMC4578861 DOI: 10.1371/journal.pone.0138790] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans. METHODS A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007-2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity. RESULTS Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70-0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with <120mmHg (fully adjusted OR 0.81; 95% CI 0.70-0.94, and 0.81; 95% CI 0.68-0.96, respectively). Prevalence of LBP in subjects with diastolic blood pressure ≥90mmHg was also significantly lower than those with <80mmHg (fully adjusted OR 0.73; 95% CI 0.63-0.85). LBP and osteoarthritis prevalence did not differ by systolic or diastolic blood pressure interval in respondents taking antihypertensive medication. LBP and osteoarthritis prevalence increased with longer hypertension duration (fully adjusted p for trend 0.028, and 0.0008, respectively). CONCLUSIONS Hypertension showed an inverse relationship with LBP and osteoarthritis prevalence, which may be ascribed to hypertension-associated hypalgesia, and antihypertensive medication intake and longer hypertension duration attenuated this association.
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Affiliation(s)
- Young-Hyeon Bae
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Ki Byung Park
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
- * E-mail:
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Delfino AE, de la Fuente N, Echevarría GC, Altermatt FR, Cortinez LI. Effect of acute arterial hypertension on morphine requirements and postsurgical pain. J Clin Anesth 2015; 27:226-32. [DOI: 10.1016/j.jclinane.2014.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/17/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
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Reyes del Paso GA, Muñoz Ladrón de Guevara C, Montoro CI. Breath-Holding During Exhalation as a Simple Manipulation to Reduce Pain Perception. PAIN MEDICINE 2015; 16:1835-41. [PMID: 25930190 DOI: 10.1111/pme.12764] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/15/2015] [Accepted: 03/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Baroreceptor stimulation yields antinociceptive effects. In this study, baroreceptors were stimulated by a respiratory maneuver, with the effect of this manipulation on pain perception subsequently measured. METHODS Thirty-eight healthy participants were instructed to inhale slowly (control condition) and to hold the air in lungs after a deep inhalation (experimental condition). It was expected that breath-holding would increases blood pressure (BP) and thus stimulate the baroreceptors, which in turn would reduce pain perception. Pain was induced by pressure algometry on the nail of the left-index finger, at three different pressure intensities, and quantified by visual analogue scales. Heart rate (HR) and BP were continuously recorded. RESULTS Pain perception was lower when pain pressure was administered during the breath-holding phase versus the slow inhalation phase, regardless of the pressure intensity. During breath-holding, a rapid increase in BP and decrease in HR were observed, demonstrating activation of the baroreceptor reflex. CONCLUSION Pain perception is reduced when painful stimulation is applied during breath-holding immediately following a deep inhalation. These results suggest that a simple and easy-to-perform respiratory maneuver could be used to reduce acute pain perception.
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Reyes del Paso GA, Montoro C, Muñóz Ladrón de Guevara C, Duschek S, Jennings JR. The effect of baroreceptor stimulation on pain perception depends on the elicitation of the reflex cardiovascular response: evidence of the interplay between the two branches of the baroreceptor system. Biol Psychol 2014; 101:82-90. [PMID: 25038302 DOI: 10.1016/j.biopsycho.2014.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 07/02/2014] [Accepted: 07/04/2014] [Indexed: 11/25/2022]
Abstract
We examined the impact of baroreceptor stimulation on pain and cardiovascular responses in 39 healthy participants. Carotid baroreceptors were stimulated with external suction (-50 mmHg, stimulation) or pressure (+8 mmHg, control). Pain was induced by pressure to the nail of the left-index finger and quantified by a visual analog scale. Pain decreased heart rate (HR) and increased blood pressure (BP). Baroreceptor stimulation further decreased HR and reduced the BP increase. Pain experience failed to differ between baroreceptor stimulation conditions. However, significant results were obtained when trials were categorized according to the magnitude of the HR deceleration elicited by baroreceptor stimulation. In trials with strong baroreceptor-elicited HR deceleration pain intensity was lower than in trials both with inactive baroreceptor stimulation (pressure trials) or trials with small baroreceptor-elicited HR responses. Anti-nociceptive effects of baroreceptor stimulation depend on the activation of the reflex cardiovascular response. Central nervous inhibition due to baroreceptor stimulation only occurs if the peripheral cardiovascular response is engaged.
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Affiliation(s)
| | | | | | - Stefan Duschek
- UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - J Richard Jennings
- Department of Psychiatry, School of Medicine, University of Pittsburgh, USA
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Proneness to worry is negatively associated with blood pressure and baroreflex sensitivity: Further evidence of the blood pressure emotional dampening hypothesis. Biol Psychol 2014; 96:20-7. [DOI: 10.1016/j.biopsycho.2013.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022]
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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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