The impact of baroreflex function on endogenous pain control: a microneurography study

Lautenschläger, Gothje; Habig, Kathrin; Best, C.; Kaps, Manfred; Elam, Mikael; Birklein, Frank; Krämer, Heidrun H.

doi:10.1111/ejn.13096

Cited by 8 publications

(5 citation statements)

References 49 publications

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“…Sustained increase of blood pressure level is considered to be an indicator of a pain regulation (‘pain killer’) mechanism [38–40]. In the present study, this pain alleviating mechanism associated with a diastolic blood pressure increase was affirmed and supported a recent finding of the impact of baroreflex function on endogenous control of acute pain coupled mainly with a diastolic blood pressure increase [41]. …”

Section: Discussionsupporting

confidence: 88%

Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices

Davydov

Naliboff

Shahabi

et al. 2016

Physiology & Behavior

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Objective This study was conducted to present evidence of differences in autonomic regulation of cardiovascular activity and its role in the severity of specific (disease-related) and non-specific (negative affect and chronic pain-related) symptoms in individuals with Irritable Bowel Syndrome (IBS). Methods Seventy-eight female patients with IBS and 27 healthy women age 18–62 years were assessed for IBS symptoms, negative affect, and baroreceptor sensitivity (BRS), blood pressure (BP), heart rate, and heart rate variability (HRV) at rest. Direct and indirect regression effects were examined with application of the bootstrap procedure to validate findings. Results IBS was reliably related to lower resting BRS, higher BP, and higher negative affect compared to healthy controls. Longer disease duration (chronicity) was related to BRS decrease coupled with systolic BP increase (95% CIs = -0.14 to -0.01). Three autonomic mechanisms associated with BRS decrease were found to further regulate severity of IBS symptoms. Lower BRS was related to higher IBS severity in general if the effect was transferred through the decrease of low frequency power of HRV (e.g., 95% CIs = -0.039 to -0.001 for abdominal pain severity). However, lower BRS was related to lower IBS severity in general if the effect was transferred through diastolic BP increase (95% CIs = 0.01 to 0.11 for abdominal pain severity). Lower BRS was related to higher abdominal pain severity coupled with high negative affect if the effect was transferred through the decrease of higher frequency power of HRV (95% CIs = -0.026 to -0.003). Conclusions These findings indicate that different cardiovascular mechanisms are associated with IBS development and the increase and decrease of severity of IBS symptoms. Their assessment suggests ways to personalize treatment of IBS.

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Section: Discussionsupporting

confidence: 88%

Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices

Davydov

Naliboff

Shahabi

et al. 2016

Physiology & Behavior

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“…Auditory Visual www.nature.com/scientificreports/ heat and cold stimulation, muscle sympathetic nerve activity was higher during heat stimulation as compared to cold stimulation in a previous study 30 . Although this result is consistent with our research results, it is necessary to investigate methods of objective pain assessment during cold stimulation.…”

Section: Control (32 °C)mentioning

confidence: 62%

Normalized skin conductance level could differentiate physical pain stimuli from other sympathetic stimuli

Sugimine

Saito

Takazawa

2020

Sci Rep

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Skin conductance monitoring is one of the promising methods for objectively evaluating pain. However, skin conductance might possibly increase in response to sympathetic stimulation other than pain. In this study, we aimed to test whether skin conductance monitoring can distinguish physical pain stimulation (heat, mechanical and cold stimulation) from other sympathetic stimuli (stimulation by noise and painful images). Twenty-three healthy volunteers participated in this prospective observational study. The number of fluctuations in skin conductance (NFSC) and normalized skin conductance level (nSCL) were measured and compared with pain scores on a self-reported pain scale (numerical pain scale [NPS]). Both NFSC and nSCL increased during mechanical stimulation. Further, nSCL, but not NFSC, well reflected heat stimulus intensity, suggesting its ability to quantitatively evaluate pain. nSCLs during physical pain stimulation were greater than those during other sympathetic stimulations. However, NFSC was not able to completely distinguish between the stimuli. These results suggest that nSCL could better differentiate physical pain stimuli from other sympathetic stimuli than NFSC. In comparisons between subjective and objective pain assessment in the same individual, nSCL correlated better with NPS score, indicating the possibility of being able to monitor the transition of pain. Monitoring changes in skin conductance using nSCL might be useful for objectively detecting physical pain. Psychometric response scales, such as the visual analogue scale, have been widely used for assessment of pain 1. This seems to be reasonable because the sensation of pain is usually affected by psychogenic factors, including mood, attention, anxiety, expectation, hypnosis and empathy 2. This fact is reflected in the following definition of pain by the International Association for the Study of Pain: An unpleasant sensory and emotional experience with actual or potential tissue damage, or described in terms of such damage 3. However, an objective pain assessment tool is still required, because verbal expression of pain is difficult for certain individuals, such as children, mentally-handicapped persons and intubated and sedated patients. Numerous studies regarding objective pain assessment have been conducted, and several physiological markers of pain, such as heart rate variability and pupillary reflexes, were proposed. However, none of them has been established as a validated marker for pain assessment so far 4,5. Among the different markers proposed, changes in skin conductance might be promising. Activation of sympathetic nerves in the skin following the experience of pain sensation and/or certain emotions, including fear and excitement, results in sweating in the palmar and plantar areas, which in turn increases skin conductance in these areas. Hence, the rationale for development of the skin conductance monitor was to detect changes in skin conductance over time 6. The principle of the skin conductance monitor raised the question r...

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“…The infusion of hypertonic saline causes long-lasting muscle pain and induces consistent increases or decreases in MSNA, depending on the individual (Kobuch et al 2015), which may be due to a combination of incoming peripheral nociceptive signals and the way the individual reacts to this. MSNA has been shown to increase during painful heat and cold (Kregel et al 1992;Lautenschläger et al 2015). The onset of skin cooling can decrease the general level of MSNA (Kregel et al 1992) and whole body warming has been shown to increase it (Niimi et al 1997).…”

Section: Introductionmentioning

confidence: 99%

Cutaneous warmth, but not touch, increases muscle sympathetic nerve activity during a muscle fatigue hand-grip task

et al. 2020

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In homeostasis, somatosensory C fibre afferents are hypothesised to mediate input to the brain about interactions with external stimuli and sympathetic efference provides the output that regulates bodily functions. We aimed to test this hypothesis and whether different types of innocuous somatosensory input have differential effects. Healthy volunteers performed a muscle fatigue (hand-grip) task to exhaustion, which produces increased muscle sympathetic nerve activity (MSNA), as measured through microneurography. Participants completed the muscle fatigue task without concurrent cutaneous sensory stimulation (control) or we applied skin warming (heat pack) as a C fibre stimulation, slow brush stroking as C and Aβ fibre stimulation, or vibration as Aβ fibre stimulation, to the participant's forearm. We also measured heart rate, the duration of the hand-grip task, and ratings of pain at the end of the task. Concurrent skin warming showed increased MSNA compared to the other conditions. Tactile stimuli (brushing, vibration) were not significantly different to the control (no intervention) condition. Warming increased the pain from the muscle contraction, whereas the tactile stimuli did not. We interpret the effect of warming on MSNA as providing relevant afferent information during muscle contraction, which needed to be counteracted via vasoconstriction to maintain homeostasis. Brushing and vibration were less homeostatically relevant stimuli for the muscle contraction and hence had no significant effect. The findings add sensory specificity to our current understanding of homeostatic regulation through somatosensory afferent and sympathetic efferent pathways.

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The impact of baroreflex function on endogenous pain control: a microneurography study

Cited by 8 publications

References 49 publications

Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices

Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices

Normalized skin conductance level could differentiate physical pain stimuli from other sympathetic stimuli

Cutaneous warmth, but not touch, increases muscle sympathetic nerve activity during a muscle fatigue hand-grip task

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