Abstract
A number of studies have indicated that exercise is associated with alterations in pain perception. In general, investigators have typically found a hypoalgesic response (i.e. diminished pain perception) to occur during and following exercise. It is currently unclear why exercise alters pain perception but some research indicates that there is an interaction between pain modulatory and cardiovascular systems. Elevated resting blood pressure (BP), such as hypertension, has been associated with reduced sensitivity to noxious stimulation. In addition, acute elevations in BP (pharmacologically) have also been associated with alterations in pain perception. Exercise elevates BP due to the physiological demands of the activity, but only a limited amount of research has been conducted examining the interaction between exercise, hypoalgesia and BP. Results from this research indicate that exercise significantly alters cardiovascular responses, and these alterations appear to be associated with alterations in pain perception. However, the interaction between exercise, pain perception and BP has been primarily examined indirectly. The mechanisms underlying the interaction between BP and pain perception are currently not entirely understood. It has been suggested that endogenous opioids may be involved in the interaction between BP and pain perception; however, results appear to be equivocal in the human research that has been conducted in this area. It has also been suggested that baroreceptor activation may play a role in the interaction between BP and pain perception.
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References
Janal MN. Pain sensitivity, exercise and stoicism. J R Soc Med 1996 Jul; 89 (7): 376–381
Koltyn KF. Analgesia following exercise: a review. Sports Med 2000 Feb; 29 (2): 85–98
Koltyn KF. Exercise-Induced hypoalgesia and intensity of exercise. Sports Med 2002; 32 (8): 477–487
O’Connor PJ, Cook DB. Exercise and pain: the neurobiology, measurement, and laboratory study of pain in relation to exercise in humans. Exerc Sport Sci Rev 1999; 27: 119–166
Ghione S. Hypertension-associated hypalgesia: evidence in experimental animals and humans, pathological mechanisms, and potential clinical consequences. Hypertension 1996 Sep; 28 (3): 494–504
Lovick TA. Integrated activity of cardiovascular and pain regulatory systems: role in adaptive behavioral responses. Prog Neurobiol 1993 May; 40 (5): 631–644
Zamir N, Maixner W. The relationship between cardiovascular and pain regulatory systems. Ann N Y Acad Sci 1986; 467: 371–384
Bruehl S, McCubbin JA, Harden RN. Theoretical review: altered pain regulatory systems in chronic pain. Neurosci Biobehav Rev 1999; 23 (6): 877–890
Randich A, Maixner W. Interactions between cardiovascular and pain regulatory systems. Neurosci Biobehav Rev 1984 Fall; 8 (3): 343–367
France CR. Decreased pain perception and risk for hypertension: considering a common physiological mechanism. Psychophysiology 1999 Nov; 36 (6): 683–692
Pertovaara A, Huopaniemi T, Virtanen A, et al. The influence of exercise on dental pain thresholds and the release of stress hormones. Physiol Behav 1984 Dec; 33 (6): 923–926
Kemppainen P, Pertovaara A, Huopaniemi T, et al. Modification of dental pain and cutaneous thermal sensitivity by physical exercise in man. Brain Res 1985 Dec 23; 360 (1–2): 33–40
Koltyn KF, Garvin AW, Gardiner RL, et al. Perception of pain following aerobic exercise. Med Sci Sports Exerc 1996 Nov; 28 (11): 1418–1421
Koltyn KF, Arbogast RW. Perception of pain after resistance exercise. Br J Sports Med 1998 Mar; 32 (1): 20–24
Koltyn KF, Trine MR, Stegner AJ, et al. Effect of isometric exercise on pain perception and blood pressure in men and women. Med Sci Sports Exerc 2001 Feb; 33 (2): 282–290
Fillingim RB, Ness TJ. Sex-related hormonal influences on pain and analgesic responses. Neurosci Biobehav Rev 2000 Jun; 24 (4): 485–501
Riley JL, Robinson ME, Wise EA, et al. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 1998 Feb; 74 (2–3): 181–187
Fillingim RB, Maixner W. The influence of resting blood pressure and gender on pain responses. Psychosom Med 1996 Jul–Aug; 58 (4): 326–332
Myers CD, Robinson ME, Riley III JL, et al. Sex, gender, and blood pressure: contributions to experimental pain report. Psychosom Med 2001 Jul–Aug; 63 (4): 545–550
Bruehl S, Chung OY. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain. Neurosci Biobehav Rev 2004 Jul; 28 (4): 395–414
Falcone C, Auguadro C, Sconocchia R, et al. Susceptibility to pain in hypertensive and normotensive patients with coronary artery disease: response to dental pulp stimulation. Hypertension 1997 Nov; 30 (5): 1279–1283
Ghione S, Rosa C, Panattoni E, et al. Comparison of sensory and pain threshold in tooth pulp stimulation in normotensive man and essential hypertension. J Hypertens Suppl 1985 Dec; 3 Suppl. 3: S113–S115
Guasti L, Cattaneo R, Rinaldi O, et al. Twenty-four-hour noninvasive blood pressure monitoring and pain perception. Hypertension 1995 Jun; 25 (6): 1301–1305
Guasti L, Zanotta D, Petrozzino MR, et al. Relationship between dental pain perception and 24 hour ambulatory blood pressure: a study on 181 subjects. J Hypertens 1999 Dec; 17 (12 Pt 2): 1799–1804
Sheps DS, Bragdon EE, Gray TF, et al. Relation between systemic hypertension and pain perception. Am J Cardiol 1992 Nov 16; 70 (16): 3F–5F
Zamir N, Shuber E. Altered pain perception in hypertensive humans. Brain Res 1980 Nov 17; 201 (2): 471–474
Rosa C, Ghione S, Panattoni E, et al. Comparison of pain perception in normotensives and borderline hypertensives by means of a tooth pulp-stimulation test. J Cardiovasc Pharmacol 1986; 8 Suppl. 5: S125–S127
Bruehl S, Carlson CR, McCubbin JA. The relationship between pain sensitivity and blood pressure in normotensives. Pain 1992 Mar; 48 (3): 463–467
Bruehl S, Chung OY, Ward P, et al. The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: the effects of opioid blockade. Pain 2002 Nov; 100 (1–2): 191–201
Fillingim RB, Maixner W, Bunting S, et al. Resting blood pressure and thermal pain responses among females: effects on pain unpleasantness but not pain intensity. Int J Psychophysiol 1998 Nov; 30 (3): 313–318
Maixner W, Fillingim R, Kincaid S, et al. Relationship between pain sensitivity and resting arterial blood pressure in patients with painful temporomandibular disorders. Psychosom Med 1997 Sep–Oct; 59 (5): 503–511
McCubbin JA, Bruehl S. Do endogenous opioids mediate the relationship between blood pressure and pain sensitivity in normotensives? Pain 1994 Apr; 57 (1): 63–67
Larbig W, Elbert T, Rockstroh B, et al. Elevated blood pressure and reduction of pain sensitivity. In: Orlebeke JF, Mulder G, van Doornen LJP, editors. Psychophysiology of cardiovascular control. New York: Plenum Press, 1985: 113–122
Keogh E, Witt G. Hypoalgesic effect of caffeine in normotensive men and women. Psychophysiology 2001 Nov; 38 (6): 886–895
O’Connor PJ, Motl RW, Broglio SP, et al. Dose-dependent effect of caffeine on reducing leg muscle pain during cycling exercise is unrelated to systolic blood pressure. Pain 2004 Jun; 109 (3): 291–298
Hoffman P. Endogenous opioid effects elicited by muscle activity [dissertation]. Goteborg, Sweden: University of Goteborg, 1990
Guasti L, Cattaneo R, Daneri A, et al. Endogenous beta-endorphins in hypertension: correlation with 24-hour ambulatory blood pressure. J Am Coll Cardiol 1996 Nov; 28 (5): 1243–1248
Cook DB, O’Connor PJ, Ray CA. Muscle pain perception and sympathetic nerve activity to exercise during opioid modulation. Am J Physiol Regul Integr Comp Physiol 2000 Nov; 279 (5): R1565–R1573
Schobel HP, Handwerker HO, Schmieder RE, et al. Effects of naloxone on hemodynamic and sympathetic nerve responses to pain in normotensives vs borderline hypertensive men. J Auton Nerv Syst 1998 Mar; 69 (1): 49–55
Bragdon EE, Light KC, Costello NL, et al. Group differences in pain modulation: pain-free women compared to pain-free men and to women with TMD. Pain 2002 Apr; 96 (3): 227–237
Dworkin BR, Elbert T, Rau H, et al. Central effects of baroreceptor activation in humans: attenuation of skeletal reflexes and pain perception. Proc Natl Acad Sci U S A 1994 Jul; 91 (14): 6329–6333
Angrilli A, Mini A, Mucha RF, et al. The influence of low blood pressure and baroreceptor activity on pain response. Physiol Behav 1997 Aug; 62 (2): 391–397
Droste C, Kardos A, Brody S, et al. Baroreceptor stimulation: pain perception and sensory thresholds. Biol Psychol 1994 Mar; 37 (2): 101–113
Kardos A, Rau H, Greenlee MW, et al. Reduced pain during baroreceptor stimulation in patients with symptomatic and silent myocardial ischemia. Cardiovasc Res 1994 Apr; 28 (4): 515–518
Rau H, Brody S, Larbig W, et al. Effects of PRES baroreceptor stimulation on thermal and mechanical pain threshold in borderline hypertensives and normotensives. Psychophysiology 1994 Sep; 31 (5): 480–485
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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
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Koltyn, K.F., Umeda, M. Exercise, Hypoalgesia and Blood Pressure. Sports Med 36, 207–214 (2006). https://doi.org/10.2165/00007256-200636030-00003
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DOI: https://doi.org/10.2165/00007256-200636030-00003