Assessment of cardiopulmonary baroreflex function in hypertensive and normotensive subjects with or without hypertensive relatives

Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain

Endogenous pain regulatory system dysfunction appears to play a role in the maintenance of chronic pain. An important component of the pain regulatory process is the functional interaction between the cardiovascular and pain regulatory systems, which results in an association between elevated resting blood pressure (BP) and diminished acute pain sensitivity. This BP/pain sensitivity relationship is proposed to reflect a homeostatic feedback loop helping restore arousal levels in the presence of painful stimuli. Evidence is emerging that this normally adaptive BP/pain sensitivity relationship is significantly altered in chronic pain conditions, affecting responsiveness to both acute and chronic pain stimuli. Several mechanisms that may underlie this adaptive relationship in healthy individuals are overviewed, including endogenous opioid, noradrenergic, and baroreceptor-related mechanisms. Theoretical models are presented regarding how chronic pain-related alterations in the mechanisms above and increased pain facilatory system activity (central sensitization) may contribute to altered BP/pain sensitivity interactions in chronic pain. Clinical implications are discussed.

Cardiopulmonary baroreflex stimulation and blood pressure-related hypoalgesia

Results from both experimental animals and humans suggest that baroreflex stimulation may be involved in blood pressure-related hypoalgesia. However, most of this research, especially in the area of human experimentation, has focused on sinoaortic baroreceptors. Cardiopulmonary baroreflex stimulation may also be an important moderator of pain. Sixty-six healthy male undergraduates varying in risk for hypertension participated in an experimental protocol in which painful mechanical finger pressure was presented three times in a counterbalanced fashion. One pain stimulus was preceded by 6 min of supine rest, another by a period of rest interspersed with periodic Valsalva manoeuvres, and another by a period in which cardiopulmonary baroreceptors were stimulated by passive leg elevation. Significantly lower pain was reported by men with relatively elevated systolic blood pressure following leg elevation but not the other conditions. Cardiopulmonary baroreflex stimulation was documented by increased forearm blood flow and other data obtained via impedance cardiography. These results suggest that blood pressure related hypoalgesia may be at least partially related to cardiopulmonary baroreflex stimulation.

Autonomic control of cardiovascular function: clinical evaluation in health and disease

The high- and low-pressure baroreceptor reflexes are integral to the control of blood pressure by the autonomic nervous system. Tests of the integrity of these baroreflexes make it possible to identify the site of autonomic dysfunction in patients with orthostatic hypotension. Clinical characteristics and typical results of autonomic testing in patients with autonomic failure, with carotid sinus hypersensitivity, and with hyperadrenergic autonomic dysfunction are described in this review.