The importance of stimulus site and intensity in differences of pain-induced vascular reflexes in human orofacial regions

An iPPG-Based Device for Pervasive Monitoring of Multi-Dimensional Cardiovascular Hemodynamics

Hemodynamic activities, as an essential measure of physiological and psychological characteristics, can be used for cardiovascular and cerebrovascular disease detection. Photoplethysmography imaging (iPPG) can be applied for such purposes with non-contact advances, however, most cardiovascular hemodynamics of iPPG systems are developed for laboratory research, which limits the application in pervasive healthcare. In this study, a video-based facial iPPG detecting equipment was devised to provide multi-dimensional spatiotemporal hemodynamic pulsations for applications with high portability and self-monitoring requirements. A series of algorithms have also been developed for physiological indices such as heart rate and breath rate extraction, facial region analysis, and visualization of hemodynamic pulsation distribution. Results showed that the new device can provide a reliable measurement of a rich range of cardiovascular hemodynamics. Combined with the advanced computing techniques, the new non-contact iPPG system provides a promising solution for user-friendly pervasive healthcare.

Effect of low-level laser therapy on tooth-related pain and somatosensory function evoked by orthodontic treatment

Low-level laser therapy (LLLT) may have an effect on the pain associated with orthodontic treatment. The aim of this study was to evaluate the effect of LLLT on pain and somatosensory sensitization induced by orthodontic treatment. Forty individuals (12–33 years old; mean ± standard deviations: 20.8 ± 5.9 years) scheduled to receive orthodontic treatment were randomly divided into a laser group (LG) or a placebo group (PG) (1:1). The LG received LLLT (810-nm gallium-aluminium-arsenic diode laser in continuous mode with the power set at 400 mW, 2 J·cm^–2) at 0 h, 2 h, 24 h, 4 d, and 7 d after treatment, and the PG received inactive treatment at the same time points. In both groups, the non-treated side served as a control. A numerical rating scale (NRS) of pain, pressure pain thresholds (PPTs), cold detection thresholds (CDTs), warmth detection thresholds (WDTs), cold pain thresholds (CPTs), and heat pain thresholds (HPTs) were tested on both sides at the gingiva and canine tooth and on the hand. The data were analysed by a repeated measures analysis of variance (ANOVA). The NRS pain scores were significantly lower in the LG group (P = 0.01). The CDTs, CPTs, WDTs, HPTs, and PPTs at the gingiva and the PPTs at the canine tooth were significantly less sensitive on the treatment side of the LG compared with that of the PG (P < 0.033). The parameters tested also showed significantly less sensitivity on the non-treatment side of the LG compared to that of the PG (P < 0.043). There were no differences between the groups for any quantitative sensory testing (QST) measures of the hand. The application of LLLT appears to reduce the pain and sensitivity of the tooth and gingiva associated with orthodontic treatment and may have contralateral effects within the trigeminal system but no generalized QST effects. Thus, the present study indicated a significant analgesia effect of LLLT application during orthodontic treatment. Further clinical applications are suggested.

Repeated applications of low-level laser therapy during and after orthodontic procedures could help reduce pain and discomfort. Many orthodontic patients experience pain in the hours and days following treatment, which impacts on treatment participation. Wenjing Chen at Nanjing Medical University and co-workers assessed whether low-level laser therapy (LLLT) can reduce pain and sensitivity in teeth and surrounding tissues. They divided 40 patients into two groups; one was given repeated LLLT in the hours and days following procedures, while the other group received a placebo course. They tested both groups for sensitivity to stimuli including heat and pressure, in the mouth and on the hands. LLLT significantly reduced pain in the mouth relative to the placebo group. No differences were found in tests on the hands, suggesting LLLT works as a targeted analgesia.

Fear of pain and event-related potentials during exposure to image-cued somatosensory stimulation

Numerous behavior studies have assessed links of pain-related fear with biases in attention towards pain stimuli but considerably less is known about neural processes underlying such biases. To address this gap, event-related potentials (ERPs) were examined as 39 high pain-fearful (Hi-FOP) and 36 low pain-fearful (Lo-FOP) adults (1) viewed non-painful versus painful images and (2) subsequently received non-painful versus possibly painful somatosensory stimulation, respectively. The Hi-FOP group judged both non-painful and painful somatosensory stimulation to be more intense than Lo-FOP group members did. Hi-FOP group members also displayed smaller N1 amplitudes than Lo-FOP group members did during image presentations, regardless of image type. Finally, Lo-FOP group members exhibited larger P3 amplitudes when processing potentially painful somatosensory stimulation compared to non-painful stimulation while no such difference was observed in Hi-FOP group members. Overall results suggested that the pain-fearful tended to exaggerate the subjective intensity of potentially painful somatosensory stimuli but allocated comparatively fewer cognitive resources to processing such stimulation; arguably, this pattern perpetuates high fear of pain levels.

Facial skin blood flow responses during exposures to emotionally charged movies

The changes in regional facial skin blood flow and vascular conductance have been assessed for the first time with noninvasive two-dimensional laser speckle flowmetry during audiovisually elicited emotional challenges for 2 min (comedy, landscape, and horror movie) in 12 subjects. Limb skin blood flow and vascular conductance and systemic cardiovascular variables were simultaneously measured. The extents of pleasantness and consciousness for each emotional stimulus were estimated by the subjective rating from -5 (the most unpleasant; the most unconscious) to +5 (the most pleasant; the most conscious). Facial skin blood flow and vascular conductance, especially in the lips, decreased during viewing of comedy and horror movies, whereas they did not change during viewing of a landscape movie. The decreases in facial skin blood flow and vascular conductance were the greatest with the comedy movie. The changes in lip, cheek, and chin skin blood flow negatively correlated (P < 0.05) with the subjective ratings of pleasantness and consciousness. The changes in lip skin vascular conductance negatively correlated (P < 0.05) with the subjective rating of pleasantness, while the changes in infraorbital, subnasal, and chin skin vascular conductance negatively correlated (P < 0.05) with the subjective rating of consciousness. However, none of the changes in limb skin blood flow and vascular conductance and systemic hemodynamics correlated with the subjective ratings. The mental arithmetic task did not alter facial and limb skin blood flows, although the task influenced systemic cardiovascular variables. These findings suggest that the more emotional status becomes pleasant or conscious, the more neurally mediated vasoconstriction may occur in facial skin blood vessels.

Painful Tooth Stimulation Elevates Matrix Metalloproteinase-8 Levels Locally in Human Gingival Crevicular Fluid

Recent studies have demonstrated that pulpal pain can induce neurogenic inflammatory reactions in gingiva and the expression of pro-inflammatory neuropeptides in gingival crevicular fluid (GCF). Neuropeptides co-ordinate the activity of immuno-effector cells and may influence the secretion of matrix metalloproteinase (MMP)-8, the major tissue-destructive protease in GCF. With this background, we studied whether experimental pulpal pain can trigger changes in GCF MMP-8 levels. The molecular forms of MMP-8 in the GCF of stimulated and non-stimulated teeth were analyzed by Western immunoblot, and MMP-8 levels by quantitative immunofluorometric assay. Painful stimulation of the upper incisor provoked significant elevations in GCF MMP-8 levels of the stimulated tooth. Western immunoblot revealed elevations in both neutrophil- and mesenchymal-type MMP-8 isoforms. At the same time, the GCF MMP-8 levels of the non-stimulated teeth were not changed. Analysis of these data indicated that pulpal pain can induce local elevations in MMP-8 levels in GCF.

Laser Doppler imaging of skin microcirculation under fiber-reinforced composite framework of facial prosthesis

OBJECTIVE

Glass-fiber reinforced composite has been suggested to be used as framework material in silicone elastomer facial prostheses. The glass-fiber reinforced framework makes it possible to make the margin of the prosthesis very tight, so that it will lean tightly against the skin even during facial expressions and jaw movements. The purpose of this study was to study how the compression of the glass-fiber reinforced framework would affect the microcirculation of the facial skin.

MATERIALS AND METHODS

A face mask, with a compression pad corresponding to the outer margin of a glass fiber-reinforced composite framework beam of a facial prosthesis, was used to apply pressure on the facial skin of healthy volunteers. The skin blood flow during touch, light and moderate compression of the skin was measured by laser Doppler imaging technique.

RESULTS

None of the compressions had any marked effects on local skin blood flow. No significant differences between the blood flow of the compressed skin, compared to the baseline values, were found.

CONCLUSIONS

The pressure applied to the skin by the tight margins of a facial prosthesis, fabricated with a framework of glass-fiber reinforced composite, does not remarkably alter the skin blood flow.

Palatability of tastes is associated with facial circulatory responses

To examine whether various types of taste stimuli in the oral cavity elicit unique changes in facial skin blood flow (SkBF) according to the palatability perceived by an individual, the facial SkBF was observed by laser speckle flowgraphy in 15 healthy subjects (11 males and 4 females) before and during the ingestion of bitter tea, chilli sauce, coffee, orange juice, soup, and a water control. The heart rate, mean arterial pressure (MAP), and SkBF in the index finger were recorded continuously. Subjects reported their subjective palatability and taste intensity scores after each stimulus. The vascular conductance indexes (CIs) in the face and finger were calculated as ratios of SkBF to MAP. CI in the eyelid increased significantly in response to chilli sauce, orange juice, and soup, whereas CIs in the forehead, nose, and cheek decreased in response to bitter tea. There was a significant correlation between the palatability scores and CI values in the eyelid when changes induced by chilli sauce were excluded. These results suggest that the facial circulatory response reflects the degree of palatability of a foodstuff.

Perinatal taurine exposure programs patterns of autonomic nerve activity responses to tooth pulp stimulation in adult male rats

Perinatal taurine excess or deficiency influences adult health and disease, especially relative to the autonomic nervous system. This study tests the hypothesis that perinatal taurine exposure influences adult autonomic nervous system control of arterial pressure in response to acute electrical tooth pulp stimulation. Female Sprague-Dawley rats were fed with normal rat chow with 3% β-alanine (taurine depletion, TD), 3% taurine (taurine supplementation, TS), or water alone (control, C) from conception to weaning. Their male offspring were fed with normal rat chow and tap water throughout the experiment. At 8-10 weeks of age, blood chemistry, arterial pressure, heart rate, and renal sympathetic nerve activity were measured in anesthetized rats. Age, body weight, mean arterial pressure, heart rate, plasma electrolytes, blood urea nitrogen, plasma creatinine, and plasma cortisol were not significantly different among the three groups. Before tooth pulp stimulation, low- (0.3-0.5 Hz) and high-frequency (0.5-4.0 Hz) power spectral densities of arterial pressure were not significantly different among groups while the power spectral densities of renal sympathetic nerve activity were significantly decreased in TD compared to control rats. Tooth pulp stimulation did not change arterial pressure, heart rate, renal sympathetic nerve, and arterial pressure power spectral densities in the 0.3-4.0 Hz spectrum or renal sympathetic nerve firing rate in any group. In contrast, perinatal taurine imbalance disturbed very-low-frequency power spectral densities of both arterial pressure and renal sympathetic nerve activity (below 0.1 Hz), both before and after the tooth pulp stimulation. The power densities of TS were most sensitive to ganglionic blockade and central adrenergic inhibition, while those of TD were sensitive to both central and peripheral adrenergic inhibition. The present data indicate that perinatal taurine imbalance can lead to aberrant autonomic nervous system responses in adult male rats.

Facial skin blood flow responses to irritant stimuli in the oral cavity

To investigate whether capsaicin and menthol stimuli elicit characteristic responses in facial skin blood flow (SkBF), we observed the facial SkBF response to low and high concentrations of capsaicin and menthol stimuli of 1-ml solution applied to the oral cavity for 20s in 17 healthy subjects. High concentration of capsaicin significantly increased the SkBF in all of the facial areas monitored. High concentration of menthol stimulus significantly decreased SkBF in the nose and increased that in the eyelid, and upper and lower lips. These results demonstrated that capsaicin and menthol stimuli in the oral cavity elicit characteristic responses in facial SkBF.

Regional differences in facial skin blood flow responses to the cold pressor and static handgrip tests

We have previously reported the unique regional responses of facial skin blood flow (SkBF) to oral application of the basic tastes without simultaneous systemic circulatory changes. In the present study, we determined whether a systemic circulatory challenge due to sympathetic activation induces regional differences in facial SkBF by observing the responses in facial SkBF and blood pressure to a 2-min cold pressor test (CPT) and static handgrip exercise (HG) by right hand in 20 healthy subjects. The CPT significantly increased SkBF in the forehead, eyelid, cheek, upper lip and lower lip by 6 ± 2 to 8 ± 2 % (mean ± SEM) as compared to resting baseline, with a significant simultaneous increase (13 ± 2 %) in mean arterial pressure (MAP), whereas it significantly decreased the SkBF in the nose by 5 ± 2 %. The HG significantly increased SkBF in the forehead, cheek and lower lip by 6 ± 3 to 10 ± 3 %, with a significant simultaneous increase in MAP (13 ± 2 %), while it induced no significant change in the other regions. Increases in SkBF were greater in the right than left cheek during CPT. These results demonstrate that a systemic circulatory challenge via sympathetic activation elicits regional differences in the facial SkBF response.

Cardiovascular responses to and modulation of pressure pain sensitivity in normotensive, pain-free women

Background and purpose The psychophysiological responses to and modulation of pressure pain stimulation are relatively new areas of investigation. The aims of the present study were to characterize subjective and cardiovascular (CV) responses to pressure pain stimulation, and to examine the relationship between CV responding and pain pressure pain sensitivity. Methods Thirty-nine pain-free, normotensive women were included in the study and tested during the follicular phase of their menstrual cycles. Pain threshold and tolerance were recorded at the right masseter muscle and the sternum, and visual analogue scales (VAS) were used to rate both pain intensity (the sensory dimension) and discomfort (the affective dimension). Mean arterial pressure (MAP), heart rate (HR), and facial and digital skin blood flux (SBF) were registered continuously. Results The pain threshold and tolerance were significantly higher at the sternum compared with the masseter, but the level of affective distress was higher at the masseter tolerance point. No associations emerged between pressure pain threshold and tolerance stimulation levels, and the corresponding VAS ratings. Pressure pain stimulation of the masseter induced significant increases in MAP, HR, and a decrease in digital SBF. During sternum pressure stimulation a significant change in HR and digital SBF was observed. There were no significant correlations between CV responding and pressure pain sensitivity. Conclusion Healthy women seem to display higher pressure pain sensitivity at the masseter region relative to the sternum. Pressure pain stimulation was associated with significant changes in MAP, HR, and SBF, but was not modulated by CV responses. The validity of these findings is strengthened by our control for menstrual cycle events, weekend-related changes in physiology, and CV changes during pain stimulation. Implications This study extends previous reports of SBF sensitivity to electrocutaneous pain into the field of pressure stimulation. Moreover, this study suggests that the often demonstrated association between high BP and low pain sensitivity may not apply to pressure pain specifically. Alternatively, this finding adds to the literature of gender differences in the relationship between CV responding and acute pain sensitivity in general.

Basic taste stimuli elicit unique responses in facial skin blood flow

Facial expression changes characteristically with the emotions induced by basic tastes in humans. We tested the hypothesis that the five basic tastes also elicit unique responses in facial skin blood flow. Facial skin blood flow was measured using laser speckle flowgraphy in 16 healthy subjects before and during the application of basic taste stimuli in the oral cavity for 20 s. The skin blood flow in the eyelid increased in response to sweet and umami taste stimuli, while that in the nose decreased in response to a bitter stimulus. There was a significant correlation between the subjective hedonic scores accompanying these taste stimuli and the above changes in skin blood flow. These results demonstrate that sweet, umami, and bitter tastes induce unique changes in facial skin blood flow that reflect subjective hedonic scores.

Psychophysiological responses to pain stimulation and cognitive tasks in female temporomandibular disorder patients

Background and purpose Psychophysiological factors may contribute to the development of temporomandibular disorders (TMD). Both local orofacial and systemic responses have been investigated. However, most studies have concentrated on physiological responding during cognitive challenges, while responses during painful tasks may be highly relevant for the development of chronic pain conditions. Moreover, the relationship between experimental challenges and physiological responding may be influenced by affective responses during the experimental tasks, an issue not often considered in the literature. Methods This study compared electromyography (EMG) of the left masseter and left trapezius muscles, orofacial and digital skin blood-flow (SBF), mean arterial pressure (MAP), and heart rate (HR) at rest, during orofacial isometric contraction, electrocutaneous pain stimulation of the left hand, pressure pain stimulation of the masseter muscle and the sternum, and three cognitive tasks (reading aloud, a simulated job interview, and visuomotoric tracking). The participants were 25 TMD patients and 25 matched pain-free controls, all females. Affective responses were assessed with the State part of the State-Trait Personality Inventory and with Visual Analogue Scales. Results Masseter EMG levels were significantly lower in the TMD group relative to the control group during jaw contraction, pressure pain stimulation, the relaxation periods, and cognitive tasks. SBF, MAP, and HR responses were largely similar in the two groups, with SBF responses to pain stimulation evident at lower levels of stimulation than previously found. The TMD patients reported significantly higher levels of negative affect during the experiment. Conclusions and implications The low EMG responses in the TMD group may be taken in support of the Pain Adaptation Model of musculoskeletal pain, in which reduced muscular activity serves to protect a painful area. However, it may also be supportive of the Integrated Pain Adaptation Model, where higher central nervous structures influence local muscular output. The group similarities in systemic physiological responding in combination with the elevated levels of negative state affect in the TMD patients confirm previous reports of psychosocial differences being more reliable indicators of TMD than generalized physiological responding.

Pain tests provoke modality-specific cardiovascular responses in awake, unrestrained rats

Nociception modulates heart rate (HR) and mean arterial pressure (MAP), suggesting their use of HR and MAP as indicators of pain in animals. We explored this with telemetric recording in unrestrained control and neuropathic (spinal nerve ligation) rats. Plantar stimulation was performed emulating techniques commonly used to measure pain, specifically brush stroke, von Frey fiber application, noxious pin stimulation, acetone for cooling, and radiant heating, while recording MAP, HR, and specific evoked somatomotor behaviors (none; simple withdrawal; or sustained lifting, shaking, and grooming representing hyperalgesia). Pin produced elevations in both HR and MAP, and greater responses accompanied hyperalgesia behavior compared to simple withdrawal. Von Frey stimulation depressed MAP, and increased HR only when stimulation produced hyperalgesia behavior, suggesting that minimal nociception occurs without this behavior. Brush increased MAP even when no movement was evoked. Cold elevated both HR and MAP whether or not there was withdrawal, but MAP increased more when withdrawal was triggered. Heating, consistently depressed HR and MAP, independent of behavior. Other than a greater HR response to pin in animals made hyperalgesic by injury, cardiovascular events evoked by stimulation did not differ between control and neuropathic animals. We conclude that (a) thermoregulation rather than pain may dominate responses to heat and cooling stimuli; (b) brush and cooling stimuli may be perceived and produce cardiovascular activation without nocifensive withdrawal; (c) sensations that produce hyperalgesia behavior are accompanied by greater cardiovascular activation than those producing simple withdrawal; and (d) von Frey stimulation lacks cardiovascular evidence of nociception except when hyperalgesia behavior is evoked.

Nasal reflexes: implications for exercise, breathing, and sex

Nasal patency, with both congestion and decongestion, is affected in a wide variety of reflexes. Stimuli leading to nasal reflexes include exercise; alterations of body position, pressure, and temperature; neurologic syndromes; and dentistry. As anticipated, the vagal and trigeminal systems are closely integrated through nasobronchial and bronchonasal reflexes. However, perhaps of greater pathophysiologic importance are the naso-hypopharyngeal-laryngeal reflexes that become aggravated during sinusitis. None other than Sigmund Freud saw deeply beyond the facial adornment and recognized the deeper sexual tensions that can regulate nasal functions and psychoanalytical status. Wine, women, and song are linked with airflow through the nose-the nose, which by any other name would still smell as sweetly.

Experimental tooth pain elevates substance P and matrix metalloproteinase-8 levels in human gingival crevice fluid

OBJECTIVE

Tooth pain can induce a neurogenic inflammatory reaction in gingiva in association with local elevations of matrix metalloproteinase (MMP)-8, which is considered the major tissue destructive protease in gingival crevice fluid (GCF). The pro-inflammatory neuropeptides released by sensory nerves coordinate the activities of the immuno-effector cells and may influence the secretion of MMP-8. With this background, we studied whether experimental tooth pain can trigger changes in GCF levels of the neuropeptide substance P (SP) and MMP-8.

MATERIAL AND METHODS

The GCF SP levels of stimulated and non-stimulated teeth were analyzed for SP using a competitive enzyme immunoassay (EIA). The GCF MMP-8 levels were determined by quantitative immunofluorometric assay (IFMA).

RESULTS

Painful stimulation of the upper central incisor caused significant elevations in GCF SP and MMP-8 levels of the stimulated tooth. At the same time, the GCF SP and MMP-8 levels of non-stimulated control teeth were unchanged.

CONCLUSIONS

These data indicate that experimental tooth pain can induce local elevations of SP and MMP-8 levels in GCF simultaneously. This supports the possibility of a local neurogenic spread of inflammatory reactions from intrapulpal to surrounding periodontal tissues.

Capsaicin-induced local elevations in collagenase-2 (matrix metalloproteinase-8) levels in human gingival crevice fluid

BACKGROUND AND OBJECTIVES

Application of capsaicin on alveolar mucosa provokes pain and neurogenic vasodilatation in the adjacent gingiva. Pain-associated inflammatory reactions may initiate expression of several pro-inflammatory mediators. Collagenase-2 (matrix metalloproteinase-8: MMP-8) is the major destructive protease, especially in the periodontitis-affected gingival crevice fluid (GCF). With this background, we wished to study whether capsaicin stimulation of alveolar mucosa can induce changes in the GCF MMP-8 levels.

MATERIAL AND METHODS

For 10 generally and periodontally healthy human volunteers, capsaicin (3%)-moistened filter paper was applied unilaterally to the buccal alveolar mucosa on the anterior maxilla. GCF samples were collected from the tooth at the stimulation site and from several other incisors in the upper jaw. MMP-8 levels and molecular forms in GCF samples were determined by immunofluorometric assay (IFMA) and western immunoblotting, respectively.

RESULTS

Capsaicin stimulation of the alveolar mucosa induced significant local elevations in levels and activation of MMP-8 in GCF of the adjacent teeth. Western immunoblot revealed that both neutrophil- and mesenchymal-type MMP-8 isoforms were elevated and activated, together with 110 kDa high-molecular size MMP-8 species. This capsaicin-evoked MMP-8 elevation lasted several minutes after stimulation. During the experiments, no marked changes occurred in MMP-8 levels in the GCF of distantly located teeth.

CONCLUSIONS

These results suggest that capsaicin-evoked neurogenic gingival inflammation can trigger the expression and activation of MMP-8 in GCF of the adjacent teeth.

Cortical representation of experimental tooth pain in humans

Cortical processing of electrically induced pain from the tooth pulp was studied in healthy volunteers with fMRI. In a first experiment, cortical representation of tooth pain was compared with that of painful mechanical stimulation to the hand. The contralateral S1 cortex was activated during painful mechanical stimulation of the hand, whereas tooth pain lead to bilateral activation of S1. The S2 and insular region were bilaterally activated by both stimuli. In S2, the center of gravity of the activation during painful mechanical stimulation was more medial/posterior compared to tooth pain. In the insular region, tooth pain induced a stronger activation of the anterior and medial parts. The posterior part of the anterior cingulate gyrus was more strongly activated by painful stimulation of the hand. Differential activations were also found in motor and frontal areas including the orbital frontal cortex where tooth pain lead to greater activations. In a second experiment, we compared the effect of weak with strong tooth pain. A significantly greater activation by more painful tooth stimuli was found in most of those areas in which tooth pain had induced more activation than hand pain. In the medial frontal and right superior frontal gyri, we found an inverse relationship between pain intensity and BOLD contrast. We concluded that tooth pain activates a cortical network which is in several respects different from that activated by painful mechanical stimulation of the hand, not only in the somatotopically organized somatosensory areas but also in parts of the 'medial' pain projection system.

Personality, affective response, and facial blood flow during brief cognitive tasks

Blood pressure, heart rate, and changes in facial and finger blood flow were monitored in 58 women during three laboratory tasks, i.e., reading out a neutral text, a personally relevant speech (including a silent preparation phase), and a tracking task. Participants rated the tasks as mild to moderate with regard to affect intensity. Significant effects of personality on affect states were demonstrated, indicating higher levels of anxiety, depression, and anger in the high-neuroticism group, and more curiosity in the high-extraversion group. Arterial pressure, heart rate, and facial blood flow increased during task performance in all three conditions. No relationship between facial blood flow changes and muscle activity measured by m. masseter electromyography (EMG) were demonstrated. Digital vasoconstriction occurred in parallel with facial vasodilatation during tracking and in the preparation phase before the speech. There were no moderator effects of neuroticism or extraversion on blood flow or other cardiovascular responses.

Effects of repeated electrocutaneous pain stimulation on facial blood flow

The purpose of the study was to examine the effects of repeated electrocutaneous pain stimulation of the hand on facial blood flow responses in healthy human subjects (58 adult women). Finger blood flow, mean arterial blood pressure, and heart rate were also monitored. To investigate the influence of psychological factors, the subjects' affect states were assessed, and physiological responding was explored during cognitive distraction, i.e., when attention was turned away from the unpleasant stimulus. Consistently, electrocutaneous stimulation elicited vasodilatation in the cheek, together with finger vasoconstriction. This response pattern was evident even at non-painful stimulation intensities. The facial blood flow response showed habituation across stimulation trials and was largely unrelated to systemic cardiovascular changes, affect states, and attentional manipulation. These findings indicate (1) that the experimentally induced facial blood flow changes are part of a non-specific physiological response pattern elicited during noxious stimulation, and (2) that they are not dependent on regional (orofacial) stimulation for their occurrence.

Cardiovascular responsiveness to brief cognitive challenges and pain sensitivity in women

The primary purpose of the study was to determine the relationship between cardiovascular (CV) responsiveness to brief cognitive tasks and pain sensitivity in normotensive individuals. Fifty-eight healthy women without a history of chronic pain were exposed to three laboratory tasks (reading aloud, speech task, and tracking task) and repeated pain testing (electrocutaneous and pressure pain stimulation) while mean arterial pressure (MAP) and heart rate (HR) were continuously recorded. Generally, subjects with higher HR responsiveness to the cognitive tasks displayed a reduced pain sensitivity, particularly to electrocutaneous pain stimulation. Moreover, the two types of pain stimulation seemed to trigger somewhat different CV response patterns. Inclusion of pain-related CV changes as control variables affected the relationship between HR responsiveness and pain sensitivity, although differently for electrocutaneous and pressure pain. However, inclusion of psychological control variables had no significant effects. Although relatively large CV changes were observed during the experimental tasks, small and insignificant changes in simultaneous or subsequent electrocutaneous pain sensitivity occurred. However, significant increases in pressure pain threshold and tolerance occurred after the speech task, during which MAP level was at its highest. The present findings support the hypothesis that pain sensitivity and CV response share a common mechanism, which, however, is not necessarily linked to either elevated blood pressure levels or other risk factors for hypertension.

Bulbar pathway for contralateral lingual nerve-evoked reflex vasodilatation in cat palate

We investigated the brain-stem pathway(s) by which electrical stimulation of the central cut end of the lingual nerve (LN) evokes parasympathetic reflex vasodilatation in the palate contralateral to the stimulated side. This occurs in artificially ventilated, cervically vagosympathectomized cats deeply anesthetized with alpha-chloralose and urethane. For this purpose, we made microinjections within the brain stem to produce nonselective, reversible local anesthesia (lidocaine) or soma-selective, irreversible neurotoxic damage (kainic acid). Local anesthesia of the trigeminal spinal nucleus (Vsp) ipsilateral to the stimulated side produced by microinjection of lidocaine (2%; 1 microl/site) reversibly and significantly reduced the LN stimulus-evoked palatal blood flow (PBF) increases. PBF increases ipsilateral and contralateral to the stimulated nerve were equally affected. In contrast, microinjection of lidocaine into the Vsp contralateral to the stimulated side did not affect these responses. Microinjection of kainic acid (10 mM/site; 1 microl) into the Vsp ipsilateral to the stimulated side led to a bilateral irreversible reduction in reflex vasodilatation in the palate. Microinjection of lidocaine into either superior salivatory nucleus (SSN) attenuated the PBF increase only on the side ipsilateral to the microinjection site. Hexamethonium (1.0 mg/kg iv) significantly reduced the vasodilator responses to electrical stimulation of Vsp by blocking ganglionic transmission on both sides. The simplest interpretation of these results is that the LN-evoked parasympathetic reflex vasodilatation in the contralateral palate depends on activation of a pathway originating from the Vsp ipsilateral to the stimulated nerve and crossing to the contralateral SSN.

Centrally mediated reflex vasodilation in the gingiva induced by painful tooth-pulp stimulation in sympathectomized human subjects

This study was designed to determine whether painful electrical stimulation of the tooth pulp induces centrally mediated reflex vasomotor changes in human gingiva and whether the sympathetic nervous system is involved in the vasomotor responses. Dynamic changes in maxillary gingival blood flow (GBF) following painful electrical stimulation of the mandibular lateral incisor were investigated, by means of laser-Doppler flowmetry, in both healthy volunteers and patients undergoing sympathetic blockade for hyperhidrosis. Increases in GBF were observed in both healthy volunteers and patients on the ipsilateral side without an increase in systemic blood pressure, but the evoked GBF increase disappeared when pain sensation was abolished by local anesthetization with 2% xylocaine solution. The vasodilator responses did not differ in amplitude between before and after the sympathectomy. These results suggest that painful tooth stimulation evokes centrally mediated reflex vasodilation, presumably via parasympathetic efferent fibers, in the human gingiva and that sympathetic vasomotor mechanisms are not involved in these responses.

Somato-sympathetic vasoconstriction to intranasal fluid administration with consecutive decrease in nasal nitric oxide

AIM

Patients suffering from non-allergic chronic rhinosinusitis (NACRS) increasingly use intranasal saline sprays. They report better nasal comfort.

METHODS

In order to better understand this phenomenon, we studied intranasal laser Doppler flowmetry (LDF) and nasal nitric oxide (NO) variations evoked by local administration of saline, histamine, N-acetylcysteine (NAC) and lidocaine at room temperature (22 degrees C).

RESULTS

There was a significant (P < 0.05) 14 +/- 3.8% decrease in LDF signal after 30 s, which lasted for 60-90 s, for all the substances applied at 22 degrees C. This pharmaco-independent vasoconstriction was further studied in patients under general anaesthesia (GA), with saline at 37 degrees C and after intranasal adrenaline treatment. While GA did not influence the vasoconstriction, saline at 37 degrees C and adrenaline pre-treatment abolished it. Nasal NO is influenced by vasoconstriction. Therefore we investigated, whether the observed vasoconstriction also changes nasal NO. A significant (P < 0.001) 8.03 +/- 0.59% decrease in nasal NO was recorded 60 s after administration of all the substances, and under GA after 22 degrees C saline application. This NO decrease was absent after intranasal adrenaline pre-treatment. An additional experiment tested the effect of nose blowing on nasal NO concentration. We registered an NO decrease with a similar pattern than observed with the other substances.

CONCLUSIONS

Intranasal fluid nebulization at 22 degrees C induces a sympathetic mediated, transient vasoconstrictor reflex response. This somato-sympathetic vasoconstriction induces a decrease in nasal NO. Both could be related to the subjective comfort experienced by NACRS patients using intranasal saline sprays.

Differences between tooth stimulation and capsaicin-induced neurogenic vasodilatation in human gingiva

Animal experiments have shown that the application of capsaicin to oral mucosa leads to a neurogenic inflammation associated with blood flow elevations in gingivomucosal tissues. In this investigation, we measured the tooth stimulation and capsaicin-evoked blood flow responses in maxillary gingiva in humans to study whether axon-reflex-mediated vasodilatation crosses the midline of the maxilla. The vasoactive reactions were mapped by laser Doppler imaging. Unilateral stimulation of alveolar mucosa and attached gingiva by capsaicin evoked a distinct neurogenic vasodilatation in ipsilateral gingiva, which rapidly attenuated at the midline. Capsaicin stimulation of alveolar mucosa provoked clear inflammatory reactions. In contrast to capsaicin stimuli, tooth stimulation produced symmetrical vasodilatations bilaterally in the gingiva. The ipsilateral responses were significantly smaller during tooth stimulation than during capsaicin stimuli. Analysis of these data suggests that capsaicin-induced inflammatory reactions in gingivomucosal tissues do not cross the midline in the anterior maxilla. The enhanced reaction found during stimulation of alveolar mucosa indicates that alveolar mucosa is more sensitive to chemical irritants than attached gingiva.

Blood flow increase in the human lip after high-intensity tooth stimulation is not based on cholinergic mechanisms

The purpose of this study was to investigate whether parasympathetic cholinergic pathways are involved in the regulation of orofacial blood flow. The effect of atropin (1 mg, iv.) on blood flow responses in the lower lip, nose and hand during painful tooth stimulation was studied in healthy human subjects (n=8). In all subjects, tooth stimulation caused a long lasting vasodilatation in the lower lip. During stimulation there was a transient elevation in heart rate (HR) and blood pressure (BP) concomitantly with a blood flow decrease in the finger and nose. With atropin, the pain-induced HR and BP elevations and blood flow reductions in the nose and finger were decreased. However, the pain-induced blood flow increase in the lip was not changed. This study indicates that the tooth stimulation-induced vasodilatation in the lip is not based on parasympathetic cholinergic mechanisms.