Comparison of Pain Perception in Normotensives and Borderline Hypertensives by Means of a Tooth Pulp-Stimulation Test

Rosa, Claudio De; Ghione, S; Panattoni, E; Mezzasalma, L; Giuliano, G

doi:10.1097/00005344-198608005-00026

Cited by 44 publications

(13 citation statements)

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“…The present study confirms and extends previous observations 10 - 12 that in humans increased arterial blood pressure is associated with reduced pain perception, as assessed by tooth pulp stimulation. Unfortunately, a cutoff value for the pain threshold had to be assigned for a number of subjects.…”

Section: Discussionsupporting

confidence: 92%

Arterial hypertension is associated with hypalgesia in humans.

et al. 1988

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SUMMARY An association between increased blood pressure and hypalgesia has been reported in several studies in animals and in a few reports in humans. We investigated the relationship between hypertension and pain perception by comparing the response to graded electrical stimulation of the tooth pulp, which is thought to represent an exclusively nodceptive system. The test was performed with a commercial tooth pulp tester in a large series of subjects with borderline or established hypertension and in three groups of normotensive controls: volunteers, nonhypertensive patients, and medical students with a well-established or no family history of hypertension. Subjects had to report when they started to feel pulp stimulation (sensory threshold) and when this became painful (pain threshold). Sensory and pain thresholds were obtained as means of the measurements on four healthy, unfilled teeth. Sensory thresholds were significantly higher hi subjects with borderline or established hypertension than in two of the three normotensive groups (volunteers and normotensive patients), whereas no significant difference was observed between the two hypertensive groups. The results for the pain threshold were qualitatively similar but less dear and less amenable to statistical analysis because this parameter could not be determined with accuracy hi a number of subjects in whom the subjective pain threshold was above the upper range of stimulation of the instrument. The association between Mood pressure levels and pain perception was further confirmed by the highly significant correlation found for the overall data between mean arterial blood pressure and both thresholds. On the other hand, no significant correlation was found with heart rate and no significant effects could be detected by analysis of variance for sex, age, and family history of hypertension. Furthermore, no changes hi pain sensitivity were observed hi a subgroup of patients studied after 3 months of diuretic or ^-blocking treatment or of low salt diet, despite significant reductions of arterial blood pressure. Taken together, our findings provide further confirmatory evidence for an increased tolerance to pain in hypertensive humans and suggest that this may be a feature of arterial hypertension irrespective of the prevailing blood pressure levels. Psychophysiological studies in the rat 2 -9 have demonstrated the association of hypalgesic behavior (delayed response to noxious stimuli such as a hot plate, an electric shock, or a mechanical force applied to a limb) to arterial hypertension. In hypertensive humans, an increased tolerance to pain, as assessed by the measurement of the pain threshold to graded electrical tooth pulp stimulation, has been reported by Zamir and Shuber 10 and confirmed in preliminary studies by our group."•

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Section: Discussionsupporting

confidence: 92%

Arterial hypertension is associated with hypalgesia in humans.

et al. 1988

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“…Higher blood pressure was related to higher pain and detection thresholds (less sensitivity). Ghione et al (1985) as well as Rosa et al (1986) also reported increased tooth pulp stimulation pain thresholds in hypertensive as compared to normotensive subjects. In the former study, 156 subjects performed pain threshold and detection threshold tasks.…”

Section: Relationship Between Tonic Blood Pressure Le6el and Pain Senmentioning

confidence: 93%

Psychophysiology of arterial baroreceptors and the etiology of hypertension

Rau

Elbert

2001

Biological Psychology

161

143

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Arterial baroreceptors are sensitive to blood pressure dependent blood vessel dilation. They play a key role in the short term regulation of blood pressure. Their impact on psychological and psychophysiological aspects is of increasing interest. The review focuses on experimental techniques for the controlled baroreceptor manipulation. Results from the application of these techniques show that baroreceptor activation influences the cardiovascular system as well as central nervous functioning: Behavioral and electrophysiological measures of arousal, low level reflexes and pain responses are modulated through baroreceptor manipulation. The observation of an overall dampening ('barbiturate like') effect of baroreceptor activity led Dworkin et al. formulate the theory of learned hypertension: Subjects might experience blood pressure dependent baroreceptor activation as stress and pain relieving. High blood pressure periods become negatively reinforced. Phasic high blood pressure might develop as a coping strategy. Data from a longitudinal human study supporting this theory are reported.

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“…Hypoalgesia has also been found in borderline hypertensives compared to normotensives (Elbert et al, 1988;Rau et al, 1994;Rosa et al, 1986;Schobel et al, 1996Schobel et al, ,1998. Moreover, hypoalgesia can extend into the normotensive blood pressure range in young adults at increased risk for hypertension, such as those with a parental history of hypertension, elevated resting blood pressure, or exaggerated cardiovascular reactivity to stress (Campbell and Ditto, 2002;France, 1999), although there are exceptions (al'Absi et al, 2000;Ghione et al, 1988).…”

Section: Introductionmentioning

confidence: 99%

Nociceptive flexion reflex thresholds and pain during rest and computer game play in patients with hypertension and individuals at risk for hypertension

Edwards

Ring

Al’Absi

et al. 2007

Biological Psychology

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Supraspinal pain modulation may explain hypertensive hypoalgesia. We compared nociceptive flexion reflex (NFR) thresholds and pain during rest and computer game play in hypertensives and normotensives (Experiment 1) and normotensives with and without hypertensive parents (Experiment 2). The game was selected to modulate activity in pain pathways. NFR thresholds did not differ between groups during rest or game play. Pain ratings never differed between hypertensives and normotensives, whereas individuals with hypertensive parents reported less pain during the first two NFR assessments, compared to those without. NFR thresholds and pain were reduced by game play compared to rest. The failure of game play to differentially modulate NFR thresholds or associated pain reports between groups argues against enhanced supraspinal modulation of nociception and pain in hypertensives and those at increased risk for hypertension.

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Comparison of Pain Perception in Normotensives and Borderline Hypertensives by Means of a Tooth Pulp-Stimulation Test

Cited by 44 publications

References 0 publications

Arterial hypertension is associated with hypalgesia in humans.

Arterial hypertension is associated with hypalgesia in humans.

Psychophysiology of arterial baroreceptors and the etiology of hypertension

Nociceptive flexion reflex thresholds and pain during rest and computer game play in patients with hypertension and individuals at risk for hypertension

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