Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA Department of Pediatrics, Vanderbilt University School of Medicine, The Monroe Carell Jr. Children's Hospital, Vanderbilt, Nashville, TN, USA Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA.
Pain. 2010 Apr;149(1):57-63. doi: 10.1016/j.pain.2010.01.009. Epub 2010 Feb 1.
Elevated resting blood pressure (BP) is hypoalgesic in healthy individuals, but this effect is absent in adults with chronic somatic pain. This study tested whether BP-related hypoalgesia is similarly altered in individuals with a history of chronic visceral pain in childhood. Resting BP was assessed in 94 adolescents and young adults with a known history of childhood functional abdominal pain (FAP) and 55 comparable healthy controls. Responses to an acute heat pain stimulus were then evaluated following exposure to two laboratory stressors. A significant participant type x systolic BP (SBP) interaction (p<.005) revealed that elevated resting SBP was associated with significantly higher heat pain threshold (p<.001) in healthy controls, but was unrelated to pain threshold in the FAP group. A similar pattern was observed for heat pain tolerance, with elevated SBP linked to significantly higher pain tolerance (p<.05) in healthy controls, but unrelated to tolerance in the FAP group. Dysfunction in BP-related hypoalgesia associated with FAP was evident regardless of whether childhood FAP had resolved or still persisted at the time of laboratory testing. Subgroup analyses indicated that BP-related hypoalgesia (in healthy controls) and FAP-linked absence of this hypoalgesia was observed only among females. Result suggest that childhood visceral chronic pain may be associated with relatively long-lasting dysfunction in overlapping systems modulating pain and BP that persists even after FAP resolves. Potential implications for later hypertension risk are discussed.
静息血压升高在健康人群中会导致痛觉迟钝，但这种效应在患有慢性躯体疼痛的成年人中并不存在。本研究旨在测试在儿童时期有慢性内脏疼痛病史的个体中，与血压相关的痛觉迟钝是否也发生了类似的变化。在已知有儿童功能性腹痛（FAP）病史的 94 名青少年和年轻成年人以及 55 名可比健康对照组中，评估了静息血压。然后，在暴露于两种实验室应激源后，评估了对急性热痛刺激的反应。显著的参与者类型 x 收缩压（SBP）交互作用（p<.005）表明，在健康对照组中，静息 SBP 升高与热痛阈值显著升高相关（p<.001），但与 FAP 组的疼痛阈值无关。热痛耐受的类似模式也存在，在健康对照组中，升高的 SBP 与显著更高的疼痛耐受相关（p<.05），但与 FAP 组的耐受无关。无论在实验室测试时儿童 FAP 是否已经解决或仍然存在，与 FAP 相关的与血压相关的痛觉迟钝功能障碍都是明显的。亚组分析表明，与血压相关的痛觉迟钝（在健康对照组中）和 FAP 相关的缺乏这种痛觉迟钝仅在女性中观察到。结果表明，儿童期内脏慢性疼痛可能与调节疼痛和血压的重叠系统中相对持久的功能障碍有关，即使 FAP 解决后这种功能障碍仍然存在。讨论了对以后高血压风险的潜在影响。
