Bruehl Stephen, Chung Ok Yung, Jirjis James N, Biridepalli Sujatha
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
Clin J Pain. 2005 Mar-Apr;21(2):147-53. doi: 10.1097/00002508-200503000-00006.
In healthy individuals, elevated blood pressure is associated with diminished acute pain sensitivity. These cardiovascular/pain regulatory system interactions appear altered in patients with chronic pain; elevated blood pressure is associated with increased acute and chronic pain responsiveness. If these alterations reflect failure of overlapping systems modulating pain and blood pressure, it was expected that prevalence of clinical hypertension would be increased in the chronic pain population.
A retrospective review was conducted on randomly selected records of 300 patients with chronic pain (Pain) evaluated at a tertiary care pain center and 300 nonpain internal medicine (Medicine) patients seen at the same institution.
Results revealed that 39% of the Pain group was diagnosed with clinical hypertension, compared with 21% of the Medicine group (P < 0.001). Analyses by sex revealed similar group differences in males (P < 0.05) and females (P < 0.001), although the difference in females was double in magnitude compared with males. In contrast to more frequent male hypertension in the general population and the Medicine sample, females were more often diagnosed with hypertension (41.2%) than males (35.6%) in the Pain group. Similar group differences were obtained for antihypertensive use (P < 0.001). Stepwise logistic regression in the Pain group revealed that chronic pain intensity was a significant predictor of hypertensive status independent of the effects of age, race/ethnicity, and parental hypertension (P < 0.05).
These results suggest that chronic pain may be associated with increased risk of hypertension. Factors that may underlie this association are discussed.
在健康个体中，血压升高与急性疼痛敏感性降低有关。这些心血管/疼痛调节系统的相互作用在慢性疼痛患者中似乎发生了改变；血压升高与急性和慢性疼痛反应性增加有关。如果这些改变反映了调节疼痛和血压的重叠系统功能失调，那么预计慢性疼痛人群中临床高血压的患病率会增加。
对在三级护理疼痛中心评估的300例慢性疼痛患者（疼痛组）和在同一机构就诊的300例非疼痛内科患者（内科组）的随机选择记录进行回顾性分析。
结果显示，疼痛组39%被诊断为临床高血压，而内科组为21%（P<0.001）。按性别分析显示，男性（P<0.05）和女性（P<0.001）中两组间均存在相似差异，尽管女性的差异幅度是男性的两倍。与普通人群和内科样本中男性高血压更常见相反，疼痛组中女性（41.2%）比男性（35.6%）更常被诊断为高血压。在抗高血压药物使用方面也获得了相似的组间差异（P<0.001）。疼痛组的逐步逻辑回归显示，慢性疼痛强度是高血压状态的显著预测因素，独立于年龄、种族/民族和父母高血压的影响（P<0.05）。
这些结果表明慢性疼痛可能与高血压风险增加有关。本文讨论了可能构成这种关联基础的因素。
