scholarly journals The effects of propranolol on heart rate variability and quantitative, mechanistic, pain profiling: a randomized placebo-controlled crossover study

2018 ◽  
Vol 18 (3) ◽  
pp. 479-489 ◽  
Author(s):  
Kristian Kjær Petersen ◽  
Hjalte Holm Andersen ◽  
Masato Tsukamoto ◽  
Lincoln Tracy ◽  
Julian Koenig ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Chronic Pain ◽  
Pain Sensitivity ◽  
Experimental Pain ◽  
Central Pain ◽  
Healthy Male ◽  
Pain Pathways ◽  
Β Blocker ◽  
Chronic Pain Conditions

AbstractBackground and aimsThe autonomic nervous system (ANS) is capable of modulating pain. Aberrations in heart rate variability (HRV), reflective of ANS activity, are associated with experimental pain sensitivity, chronic pain, and more recently, pain modulatory mechanisms but the underlying mechanisms are still unclear. HRV is lowered during experimental pain as well as in chronic pain conditions and HRV can be increased by propranolol, which is a non-selective β-blocker. Sensitization of central pain pathways have been observed in several chronic pain conditions and human mechanistic pain biomarkers for these central pain pathways include temporal summation of pain (TSP) and conditioned pain modulation (CPM). The current study aimed to investigate the effect of the β-blocker propranolol, and subsequently assessing the response to standardized, quantitative, mechanistic pain biomarkers.MethodsIn this placebo-controlled, double-blinded, randomized crossover study, 25 healthy male volunteers (mean age 25.6 years) were randomized to receive 40 mg propranolol and 40 mg placebo. Heart rate, blood pressure, and HRV were assessed before and during experimental pain tests. Cuff pressure pain stimulation was used for assessment of pain detection (cPDTs) and pain tolerance (cPTTs) thresholds, TSP, and CPM. Offset analgesia (OA) was assessed using heat stimulation.ResultsPropranolol significantly reduced heart rate (p<0.001), blood pressure (p<0.02) and increased HRV (p<0.01) compared with placebo. No significant differences were found comparing cPDT (p>0.70), cPTT (p>0.93), TSP (p>0.70), OA-effect (p>0.87) or CPM (p>0.65) between propranolol and placebo.ConclusionsThe current study demonstrated that propranolol increased HRV, but did not affect pressure pain sensitivity or any pain facilitatory or modulatory outcomes.ImplicationsAnalgesic effects of propranolol have been reported in clinical pain populations and the results from the current study could indicate that increased HRV from propranolol is not associated with peripheral and central pain pathways in healthy male subjects.

Reduction in Pain Sensitivity from Pharmacological Elevation of Blood Pressure in Persons with Chronically Low Blood Pressure

2009 ◽  
Vol 23 (3) ◽  
pp. 104-112 ◽  
Author(s):  
Stefan Duschek ◽  
Heike Heiss ◽  
Boriana Buechner ◽  
Rainer Schandry
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Pain Perception ◽  
Drug Effects ◽  
Pressure Effects ◽  
Double Blind ◽  
Low Blood Pressure ◽  
Present Trial

Recent studies have revealed evidence for increased pain sensitivity in individuals with chronically low blood pressure. The present trial explored whether pain sensitivity can be reduced by pharmacological elevation of blood pressure. Effects of the sympathomimetic midodrine on threshold and tolerance to heat pain were examined in 52 hypotensive persons (mean blood pressure 96/61 mmHg) based on a randomized, placebo-controlled, double-blind design. Heat stimuli were applied to the forearm via a contact thermode. Confounding of drug effects on pain perception with changes in skin temperature, temperature sensitivity, and mood were statistically controlled for. Compared to placebo, higher pain threshold and tolerance, increased blood pressure, as well as reduced heart rate were observed under the sympathomimetic condition. Increases in systolic blood pressure between points of measurement correlated positively with increases in pain threshold and tolerance, and decreases in heart rate were associated with increases in pain threshold. The findings underline the causal role of hypotension in the augmented pain sensitivity related to this condition. Pain reduction as a function of heart rate decrease suggests involvement of a baroreceptor-related mechanism in the pain attrition. The increased proneness of persons with chronic hypotension toward clinical pain is discussed.

scholarly journals Gender Differences in Response to Experimental Pain among Medical Students from a Western State of India

2014 ◽  
Vol 2 (1) ◽  
pp. 13-17
Author(s):  
Pratik Akhani ◽  
Samir Mendpara ◽  
Bhupendra Palan
Keyword(s):  
Blood Pressure ◽  
Gender Differences ◽  
Medical Students ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Experimental Pain ◽  
Pain Tolerance ◽  
Medical Attention ◽  
Pain Rating ◽  
Western State

Background: Pain is one of the most common reasons for patients to seek medical attention and it causes considerable human suffering. Pain is a complex perception that differs enormously among individual patients. Gender plays an important role in how pain is experienced, coped with and treated. Even young healthy individuals often differ in how they perceive and cope with pain. This study was done to investigate gender differences in response to experimental pain among medical students from a western state in India. Methods: A total of 150 medical students (86 males and 64 females) participated in this interventional study. The Cold Pressor Test was used to exert experimental pain. To study the response, cardiovascular measures (radial pulse, systolic blood pressure and diastolic blood pressure) and pain sensitivity parameters (pain threshold, pain tolerance and pain rating) were assessed. Results: No significant difference was found in cardiovascular response to experimental pain between both the genders (p>0.05). Pain threshold and pain tolerance were found to be significantly higher in males whereas pain rating was found to be significantly higher in females (p<0.01). Pulse reactivity showed a negative relationship with pain threshold and pain tolerance whereas a positive relationship with pain rating, however no statistically significant relation was found between these measures. Conclusion: Females display greater pain sensitivity than males. Different pain perception might account for gender difference in pulse reactivity.

scholarly journals Experimentally induced pain does not influence updating of peripersonal space and body representations following tool-use

2018 ◽  
Author(s):  
Axel Davies Vittersø ◽  
Monika Halicka ◽  
Gavin Buckingham ◽  
Michael J Proulx ◽  
Mark Wilson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Tool Use ◽  
Experimental Pain ◽  
Peripersonal Space ◽  
The Body ◽  
Body Representations ◽  
Tactile Target ◽  
The Difference ◽  
Chronic Pain Conditions ◽  
Crossmodal Congruency

Representations of the body and peripersonal space can be distorted for people with some chronic pain conditions. Experimental pain induction can give rise to similar, but transient distortions in healthy individuals. However, spatial and bodily representations are dynamic, and constantly update as we interact with objects in our environment. It is unclear whether induced pain disrupts the mechanisms involved in updating these representations. In the present study, we sought to investigate the effect of induced pain on the updating of peripersonal space and body representations during and following tool-use. We compared performance under three conditions (pain, active placebo, neutral) on a visuotactile crossmodal congruency task and a tactile distance judgement task to measure updating of peripersonal space and body representations, respectively. We induced pain by applying 1% capsaicin cream to the arm, and for placebo we used a gel that induced non-painful warming. Consistent with previous findings, the difference in crossmodal interference from visual distractors in the same compared to opposite visual field to the tactile target was less when tools were crossed than uncrossed. This suggests an extension of peripersonal space to incorporate the tips of the tools. Also consistent with previous findings, estimates of the felt distance between two points (tactile distance judgements) decreased after active tool-use. In contrast to our predictions, however, we found no evidence that pain interfered with performance on either task when compared to the control conditions. This suggests that the updating of peripersonal space and body representations is not disrupted by induced pain. Therefore, acute pain does not account for the distorted representations of the body and peripersonal space that can endure in people with chronic pain conditions.

scholarly journals P1462IMPACT OF HEART RATE AND BETA-BLOCKER USE ON THE LONG-TERM SURVIVAL OF CHRONIC HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Takuhiro Moromizato ◽  
Kunitoshi Iseki ◽  
OCTOPUS Study Group
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cox Regression ◽  
Chronic Hemodialysis ◽  
Time Varying ◽  
Term Survival ◽  
Blood Pressures ◽  
Β Blocker ◽  
Time Varying Covariates

Abstract Background and Aims Increase in resting heart rate might influence mortalities of dialysis patients, and the use of β-blocker might improve their survival probability. However, the influence of heart rate and benefits of β-blocker on their survival are difficult to quantify because of following obstacles: prone to measurement errors; inherent association of heart rate with blood pressures, comorbidities, and medication use; and a necessity of repeated measurements of vital signs and medication use. Therefore, at the design process of our previous randomized control trial on the Olmesartan Clinical Trial in Okinawan patients under OKIDS (OCTOPUS), we included the repeated measures design to quantify the influence of vital sign values on the survival retrospectively. We combined the repeated measurement data and additional the long-term prognosis information of the participants obtained after the OCTOPUS with aim of investigating the influence of time varying covariates: heart rates, blood pressures, and β-blocker use, on the long-term survival of hemodialysis patients. Method We investigated 461 adult OCTOPUS participants who received chronic hemodialysis and antihypertensive medications in Okinawa. The OCTOPUS trial, which was conducted between June 2006 and June 2011, did not detect the survival benefit of angiotensin receptor blocker (ARB)NDT 2013, but the study and the additional follow-up of participants’ prognosis provided us with information to investigate influence of predictors on long-term survival in the population. Throughout the OCTOPUS trial, study participants were measured pre-dialysis blood pressures, pre-dialysis resting heart rates, and their medication use for one week at their dialysis centers every six months after their participations. Following the trial, we collected the prognosis information of all participants until July 31st, 2018. Finally, we merged the multiple-measured data during the OCTOPUS with the prognosis data. Mean values of three measurements of blood pressures and heart rates and β-blocker use were introduced to the Cox-regression model as time-varying covariates with essential non-time varying covariates, which include age, gender, and diabetes. Results In this retrospective cohort study, 221 (47.9%) out of 461 participants deceased, and the median follow-up length was 10.21 years. Initial mean resting heart rate and pre-dialysis mean blood pressure were 78(±10) per minute and 159.5(±14) mmHg, respectively. 10% of participants were prescribed β-blocker initially. The resting heart rate of all participants significantly decreased by 1.75 and 2.45 per minutes after two and four years respectively. β-blocker could significantly decrease the mean heart rate by 3.54 and 2.90 per minutes after two and four years. With our Cox-regression with the time varying covariates, increase of heart rate was significantly associated with higher mortality (P=0.002), but the use of β-blocker was not associated with the mortality. (P=0.691) Additionally, we could not detect the interaction of heart rate and β-blocker use on the mortality. (P= 0.796) Although lower blood pressure was significantly associated with higher mortality in our initial Cox-regression analysis, an introduction of interaction term of heart rate and blood pressure remove the significance of influence of blood pressure on the survival. Conclusion In hypertensive chronic hemodialysis patients, higher heart rate is associated with higher mortality. However, use of beta-blocker was not associated with improvement of their mortality.

Ambulatory blood pressure and heart rate in healthy male paramedics during a workday and a nonworkday.

1992 ◽  
Vol 11 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Iris B. Goldstein ◽  
Larry D. Jamner ◽  
David Shapiro
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Ambulatory Blood Pressure ◽  
Healthy Male

Pain medicine

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Strategies ◽  
Multidisciplinary Management ◽  
Pain Medicine ◽  
Pain Pathways ◽  
Patient Groups ◽  
Chronic Pain Conditions ◽  
Sites Of Action ◽  
Specific Management

This chapter summarizes the assessment and management of acute and chronic pain for FRCA. Pain pathways and physiological consequences of pain are considered along with sites of action and the pharmacology of common analgesics. Assessment of pain for different patient groups and settings is explained. Pain management strategies, pharmacological, non-interventional and interventional techniques are described, including multidisciplinary management of chronic pain. Specific management of some common chronic pain conditions, such as trigeminal neuralgia, are discussed in more detail.

scholarly journals Spider Knottin Pharmacology at Voltage-Gated Sodium Channels and Their Potential to Modulate Pain Pathways

Toxins ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 626 ◽  
Author(s):  
Yashad Dongol ◽  
Fernanda Caldas Cardoso ◽  
Richard J Lewis
Keyword(s):  
Chronic Pain ◽  
Sodium Channels ◽  
Structural Features ◽  
Voltage Gated ◽  
Subtype Selectivity ◽  
Voltage Gated Sodium Channels ◽  
Neuronal Signalling ◽  
Pain Pathways ◽  
Nav Channels ◽  
Chronic Pain Conditions

Voltage-gated sodium channels (NaVs) are a key determinant of neuronal signalling. Neurotoxins from diverse taxa that selectively activate or inhibit NaV channels have helped unravel the role of NaV channels in diseases, including chronic pain. Spider venoms contain the most diverse array of inhibitor cystine knot (ICK) toxins (knottins). This review provides an overview on how spider knottins modulate NaV channels and describes the structural features and molecular determinants that influence their affinity and subtype selectivity. Genetic and functional evidence support a major involvement of NaV subtypes in various chronic pain conditions. The exquisite inhibitory properties of spider knottins over key NaV subtypes make them the best lead molecules for the development of novel analgesics to treat chronic pain.

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