Ischemic Preconditioning: Modulating Pain Sensitivity and Exercise Performance

Abstract

Purpose The purpose of this study was to examine whether an individual’s IPC-mediated change in cold pain sensitivity is associated with the same individual’s IPC-mediated change in exercise performance.Methods Thirteen individuals (8 males; 5 females, 27 ± 7 years, 55 ± 5 ml.kgs–1.min–1) underwent two separate cold-water immersion tests: with preceding IPC treatment and without. In addition, each participant undertook two separate 5-km cycling time trials: with preceding IPC treatment and without. Pearson correlation coefficients were used to assess the relationship between an individual’s change in cold-water pain sensitivity following IPC with their change in 5-km time trial performance following IPC.Results During the cold-water immersion test, pain intensity increased over time (p < 0.001) but did not change with IPC (p = 0.96). However, IPC significantly reduced the total time spent under pain (−9 ± 7 s; p = 0.001) during the cold-water immersion test. No relationship was found between an individual’s change in time under pain (r = −0.2, p = 0.6) or pain intensity (r = −0.3, p = 0.3) following IPC and their change in performance following IPC.Conclusion These findings suggest that IPC can modulate sensitivity to a painful stimulus, but this altered sensitivity does not explain the ergogenic efficacy of IPC on 5-km cycling performance.

Remote ischaemic preconditioning increase tolerance to experimentally induced cold pain

“…Pain tolerance was increased with a large effect (approximately 30 s; d = 1.11‐1.41) with one, two and three cycles of IPC in comparison to sham (see Figure 2(a)), and this hypoalgesic effect was observed in thirteen out of fourteen of the analysed participants. This is the first study to demonstrate an increase cold pain tolerance after IPC, and this was unlikely driven by a lower intensity of pain perceived as after the first 30 s of hand submersion pain intensity was not different between conditions, indicating that the perception during the test may not have been altered which is in agreement with previous work using cold pain (Slysz & Burr, 2021). However, it should be noted that due to short tolerance times (30–60 s) in multiple participants, we were unable to analyse data over more than one time point, and a higher resolution of pain intensity assessment (e.g.…”

“…Mechanical pressure pain intensity has also been shown to be reduced after remote IPC in males, but not females, which warrants further investigation into potential sex‐differences (Pereira et al, 2020). Finally, work by Slysz and Burr (2021) found that IPC of the upper limb reduced the total time under pain after two minutes of cold‐water immersion of the same hand, and IPC has also been shown to increase vasoconstriction during cold‐water immersions, but unfortunately, no measures of pain were assessed (Horiuchi et al, 2015) Therefore, it is still not well established if remote IPC can induce hypoalgesia. It is also currently unclear as to whether remote IPC can induce a robust hypoalgesic response.…”

Potential physiological responses contributing to the ergogenic effects of acute ischemic preconditioning during exercise: A narrative review

“…Despite similar avoidance behaviours, pain and RPE are distinct subjective perceptions ( Marcora, 2009 ). Moreover, reduced subjective pain ratings following IPC were not shown to influence RPE during fatiguing plantar flexion exercise and did not correlate with the ergogenic effects during exercise ( Pereira et al, 2020 ; Slysz and Burr, 2021 ). This suggests that altered pain sensitivity does not govern the ergogenic response which is consistent with previous assertions that afferent feedback is independent from effort perception ( Marcora, 2009 ).…”

“…Perhaps lending further support to the muscle afferent hypothesis is the evidence of IPC inducing hypoalgesic effects in humans. Indeed, previous investigations have demonstrated IPC techniques to reduce pressure pain ratings, pain under ischemia, perceived pain following eccentric exercise induced muscle damage, and time spent under pain during cold-water immersion tests ( Ferreira et al, 2016 ; Pereira et al, 2020 ; Slysz and Burr, 2021 ; Angius et al, 2022 ). IPC-induced hypoalgesia may be governed by endogenous substances that have antinociceptive effects on pain pathways.…”

Intra‐ and interindividual reliability of muscle pain induced by an intramuscular injection of hypertonic saline injection into the quadriceps

“…To our knowledge, there are currently no studies that have formally assessed the test–retest reliability of other commonly employed experimental models of tonic muscle pain, such as the cold‐pressor test (Angius et al, 2015; Slysz & Burr, 2021) and ischaemic contractions (Jones et al, 2014; O'Leary et al, 2017). Conversely, the reliability of the pain response elicited from techniques such as cuff and point pressure algometry, which provide a measure of pain pressure threshold have been well established (for example, Chesterton et al, 2007; Graven‐Nielsen et al, 2015; Kvistgaard Olsen et al, 2017; Nussbaum & Downes, 1998).…”