Document Detail

Hemodynamic and sympathetic nerve responses to painful stimuli in normotensive and borderline hypertensive subjects.
MedLine Citation:
PMID:  8880832     Owner:  NLM     Status:  MEDLINE    
Observations in animals and humans show that pain sensitivity might be lower (and pain tolerance higher) in hypertensive as compared to normotensive subjects. One hypothesis, derived from experimental studies, assumes that enhanced activation of baroreceptors leads to an enhanced central inhibition. A central hypothesis assumes changes in the central (endogenous) control of the nociceptive system. To investigate these two hypotheses we quantitatively assessed the minute-by-minute changes in mean arterial pressure (MAP), central venous pressure (CVP) heart rate (HR), muscle sympathetic nerve activity (MSNA), and individual pain ratings during noxious mechanostimulation in 10 normotensive (NT) and 13 borderline hypertensive (BH) subjects. Linear regression analysis indicated a close negative correlation for the overall data between resting levels of MAP and pain ratings (r = -0.57, P < 0.0001). The BH group exhibited a lower pain sensitivity compared to the NT group (P < 0.001). The extent of baroreceptor activation during the application of pain was not different between the two groups (P = NS) as assessed by almost identical increases in MAP (+8 +/- 1 vs. +9 +/- 1 mmHg NT vs. BH group), CVP (+0.7 +/- 0.1 vs. +0.5 +/- 0.1 mmHg), HR (+2 +/- 1 vs. +2 +/- 1 beats/min), and MSNA (+5 +/- 1 +4 +/- 1 bursts/min). The NT subjects exhibited significant correlations between the pain ratings and the increases in MAP (r = +0.52; P < 0.05) and MSNA (r = +0.49; P < 0.05) whereas the BH subjects did not show such a relationship. Thus, the increased pain tolerance in human hypertension cannot be explained by hemodynamically mediated differences in the activation of baroreceptors or by an altered baroreflex sensitivity during the application of pain. We conclude, that the reduced pain sensitivity in hypertensive humans is more likely related to central changes.
H P Schobel; M Ringkamp; A Behrmann; C Forster; R E Schmieder; H O Handwerker
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pain     Volume:  66     ISSN:  0304-3959     ISO Abbreviation:  Pain     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1997-03-06     Completed Date:  1997-03-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7508686     Medline TA:  Pain     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  117-24     Citation Subset:  IM    
Department of Internal Medicine, University of Erlangen-Nürnberg, Germany.
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MeSH Terms
Baroreflex / physiology
Blood Pressure / physiology
Catecholamines / blood
Central Venous Pressure / physiology
Hemodynamics / physiology*
Hypertension / blood,  physiopathology*
Pain / blood,  physiopathology*
Pain Measurement
Physical Stimulation
Regression Analysis
Sympathetic Nervous System / physiopathology*
Reg. No./Substance:

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