Elevated pain threshold in patients with effort‐induced angina pectoris and asymptomatic myocardial ischemia during exercise test

Pedersen, Flemming; Pietersen, Adrian; Madsen, Jan Kyst; Ballegaard, Søren; Meyer, Chloe; Trojaborg, W.

doi:10.1002/clc.4960121106

Cited by 18 publications

(5 citation statements)

References 17 publications

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“…There are no consistent differences in the severity or duration of myocardial ischemia between silent and symptomatic episodes (6)(7)(8). There are, however, generalized differences in pain threshold and tolerance between individuals with predominantly silent versus predominantly symptomatic ischemia (9)(10)(11)(12). These differences may be associated with underlying variation in endogenous opioid activity, but other central nervous system (CNS) factors are probably involved as well (13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 86%

“…Some symptomatic patients tend to complain of chest pain early in the course of ischemic episodes, even if their symptoms are relatively mild, whereas others endure prolonged ischemia before reporting any symptoms (12,31). The relationship between delayed reporting and nonreporting (i.e., silent ischemia) has not been systematically investigated.…”

Section: Introductionmentioning

confidence: 97%

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Psychological factors in silent myocardial ischemia.

Freedland

Carney

Krone

et al. 1991

Psychosomatic Medicine

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To determine whether psychological factors differentiate patients with silent versus symptomatic myocardial ischemia, a battery of psychometric tests was administered to 68 patients with positive thallium stress tests. Compared with patients who became symptomatic (n = 25), patients with silent ischemia on the treadmill (n = 24) were less often aware of cardiac and other bodily sensations (p less than 0.005) and were less avoidant of harm or pain in general (p less than 0.05). They did not differ on variables associated with symptom reporting biases. To clarify the relationship between ischemia and symptom reporting, symptomatic patients were subgrouped on the basis of anginal pain latency. Psychologically, the patients with silent ischemia were most similar to patients with the longest pain latencies and most different from those who reported angina before the onset of ST depression. The psychological profile of patients with silent ischemia during exercise testing is consistent with a reduced sensitivity to pain and other bodily sensations.

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 97%

Psychological factors in silent myocardial ischemia.

Freedland

Carney

Krone

et al. 1991

Psychosomatic Medicine

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“…Several studies have been reported to illustrate difference of pain thresholds between on some pain tests in silent MI and symptomatic MI (2,3). However, few was to be reported about whether the different analgesic could have various influence to pain threshold.…”

Section: Introductionmentioning

confidence: 99%

Effects of dezocine, morphine and nalbuphine on electropain threshold, temperature pain threshold and cardiac function in rats with myocardial ischemia

Dong¹,

Liang²,

Xu³

et al. 2020

Ann Palliat Med

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Background: Myocardial ischemia (MI) could cause many complications, such as arrhythmia, ischemic cardiomyopathy, which could lead to angina and myocardial infarction. The clinical efficacy of dezocine, morphine and nalbuphine are becoming dominated in China market. This aim of this study was to investigate the effects of dezocine, morphine and nalbuphine on electrical pain threshold, temperature pain threshold and cardiac function in rats with MI.Methods: A rat model of MI was established by ligating the coronary artery. Rats in the model group were injected with dezocine, morphine, nalbuphine and 0.9% normal saline. The effects of the three analgesics on MI rats were evaluated by comparing the electrical pain threshold, temperature pain threshold, and cardiac function index. Results:The electrocardiogram revealed that the model of MI was successful. The results of the electrical pain threshold and temperature pain threshold tests revealed that nalbuphine was the most sensitive after medication, followed by dezocine, and the sensitivity of morphine was the lowest. These three drugs reached its peak at two hours after administration. The analgesic effect of dezocine on electrical stimulation was the best, while nalbuphine had the best effect on temperature. The efficacy of dezocine decreased with time, while morphine basically failed at four hours after administration. The peak time of these three kinds of analgesics was selected to detect the cardiac function index in each group. Morphine had the least influence on the cardiac function index of rats, followed by nalbuphine and dezocine.Conclusions: These results show that the analgesic effect of nalbuphine had the earliest and best effect with the longest duration on temperature, and had less influence and higher safety in the cardiac function test of MI rats. Hence, nalbuphine is a relatively good analgesic for MI patients. The present study provides a database for the selection of analgesics in patients with MI.

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“…Similarly,patients with silent ischemia showed decreased sensitivity to electrical pain, ischemic arm pain, and cold pressor pain (Droste & Roskamm, 1983). These results have been replicated by others (Droste, Meyer Blankenburg, Greenlee, & Roskamm, 1988;Pedersen, Pietersen, Madsen, Ballegaard, Meyer, & Trojaborg, 1989); however, one study reported no differences in pain perception in silent versus symptomatic ischemics (Glusman, Coromilas, Clark,Janal, Blood, KuW, & Burns, 1996). The patients with silent ischemia had significandy higher pain thresholds than symptomatic ischemics.…”

Section: Pain Perception In Coronary Artery Disease and Other Cardiacmentioning

confidence: 74%