Author:
Davydov Dmitry M.,de la Coba Pablo,Contreras-Merino Ana M.,Reyes del Paso Gustavo A.
Abstract
AbstractContrasting findings on the mechanisms of chronic pain and hypertension development render the current conventional evidence of a negative relationship between blood pressure (BP) and pain severity insufficient for developing personalized treatments. In this interdisciplinary study, patients with fibromyalgia (FM) exhibiting clinically normal or elevated BP, alongside healthy participants were assessed. Different pain sensitization responses were evaluated using a dynamic 'slowly repeated evoked pain' (SREP) measure, as well as static pain pressure threshold and tolerance measures. Cardiovascular responses to clino-orthostatic (lying-standing) challenges were also examined as acute re- and de-hydration events, challenging cardiovascular and cerebrovascular homeostasis. These challenges involve compensating effects from various cardiac preload or afterload mechanisms associated with different homeostatic body hydration statuses. Additionally, hair cortisol concentration was considered as a factor with an impact on chronic hydration statuses. Pain windup (SREP) and lower pain threshold in FM patients were found to be related to BP rise during clinostatic (lying) rehydration or orthostatic (standing) dehydration events, respectively. These events were determined by acute systemic vasoconstriction (i.e., cardiac afterload response) overcompensating for clinostatic or orthostatic cardiac preload under-responses (low cardiac output or stroke volume). Lower pain tolerance was associated with tonic blood pressure reduction, determined by permanent hypovolemia (low stroke volume) decompensated by permanent systemic vasodilation. In conclusion, the body hydration status profiles assessed by (re)activity of systemic vascular resistance and effective blood volume-related measures can help predict the risk and intensity of different pain sensitization components in chronic pain syndrome, facilitating a more personalized management approach.
Funder
Spanish Ministry of Science, Innovation and Universities
Publisher
Springer Science and Business Media LLC
Reference99 articles.
1. Davydov, D. M. Linking the heart and pain: Physiological and psychophysiological mechanisms. In Features and Assessments of Pain, Anaesthesia, and Analgesia (a Volume of The Neuroscience of Pain, Anesthetics, and Analgesics) Vol. I(II) (eds Rajendram, R. et al.) 211–223 (Academic Press Inc, 2022).
2. Bruehl, S. & Chung, O. Y. Interactions between the cardiovascular and pain regulatory systems: An updated review of mechanisms and possible alterations in chronic pain. Neurosci. Biobehav. Rev. 28, 395–414 (2004).
3. Davydov, D. M. Impact of antihypertensive treatment on resiliency to clinical pain. J. Hypertens. 38, 961–967 (2020).
4. Spence, J. D., Grosser, T. & Fitzgerald, G. A. Acetaminophen, nonsteroidal anti-inflammatory drugs, and hypertension. Hypertension 79, 1922–1926 (2022).
5. Guasti, L. et al. Treatment with enalapril modifies the pain perception pattern in hypertensive patients. Hypertension 31, 1146–1150 (1998).