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The relationship between resting blood pressure and acute pain sensitivity: effects of chronic pain and alpha-2 adrenergic blockade

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Abstract

This study tested for alpha-2 adrenergic mediation of the inverse relationship between resting blood pressure and acute pain sensitivity in healthy individuals. It also replicated limited prior work suggesting this inverse blood pressure/pain association is altered in chronic pain, and provided the first test of whether chronic pain-related changes in alpha-2 adrenergic function contribute to these alterations. Resting blood pressure was assessed in 32 healthy controls and 24 chronic low back pain participants prior to receiving placebo or an intravenous alpha-2 adrenergic receptor antagonist (yohimbine hydrochloride, 0.4 mg/kg) in a randomized crossover design. Participants experienced three acute pain tasks during both sessions. A significant Systolic Blood Pressure × Participant Type × Drug interaction on finger pressure McGill Pain Questionnaire-Sensory ratings (P < .05) reflected significant hyperalgesic effects of yohimbine in chronic pain participants with lower systolic blood pressures (P < .05) but not those with higher systolic pressures, and no significant effects of yohimbine in controls regardless of blood pressure level. A Drug × Systolic Blood Pressure interaction on finger pressure visual analog scale unpleasantness indicated the inverse blood pressure/pain association was significantly stronger under yohimbine relative to placebo (P < .05). Significant Participant Type × Systolic Blood Pressure interactions (P’s < .05) were noted for finger pressure visual analog scale pain intensity and unpleasantness, ischemic pain threshold, and heat pain threshold, reflecting absence or reversal of inverse blood pressure/pain associations in chronic pain participants. Results suggest that blood pressure-related hypoalgesia can occur even when alpha-2 adrenergic systems are blocked. The possibility of upregulated alpha-2 adrenergic inhibitory function in chronic pain patients with lower blood pressure warrants further evaluation.

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Acknowledgments

This research was supported by NIH Grant NS046694 and GCRC grant M01 RR-00095 from the NCRR/NIH. The authors gratefully acknowledge the contributions of Melissa Chont and the assistance of the research nurses of the Vanderbilt General Clinical Research Center, as well as the technical assistance of Dr. Roger Fillingim regarding the thermal pain stimulus.

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Authors and Affiliations

  1. Department of Anesthesiology, Vanderbilt University School of Medicine, 701 Medical Arts Building, 1211 Twenty-First Avenue South, Nashville, TN, 37212, USA

    Stephen Bruehl, Ok Y. Chung & Laura Diedrich

  2. Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, USA

    André Diedrich & David Robertson

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  1. Stephen Bruehl
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  2. Ok Y. Chung
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Correspondence to Stephen Bruehl.

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Bruehl, S., Chung, O.Y., Diedrich, L. et al. The relationship between resting blood pressure and acute pain sensitivity: effects of chronic pain and alpha-2 adrenergic blockade. J Behav Med 31, 71–80 (2008). https://doi.org/10.1007/s10865-007-9133-4

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  • DOI: https://doi.org/10.1007/s10865-007-9133-4

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