慢性背痛患者心肺压力感受器的抗伤害感受特性

Anti-nociceptive properties of cardiopulmonary baroreceptors in patients with chronic back pain.

作者信息

Iwakuma Yuto, Liu Jennifer, Clonch Davina A, Gangwish Megan E, Lam Christopher M, Holwerda Seth W

机构信息

Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, United States.

College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United States.

出版信息

Front Pain Res (Lausanne). 2025 Jul 25;6:1593939. doi: 10.3389/fpain.2025.1593939. eCollection 2025.

DOI:10.3389/fpain.2025.1593939

PMID:40786621

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12331587/

Abstract

INTRODUCTION

Reduced pain perception following a persistent noxious stimulus during a study session (short-term habituation) is believed to be partially mediated by descending inhibitory mechanisms, although these mechanisms have not been fully elucidated. We examined the hypothesis that cardiopulmonary baroreceptor would significantly increase short-term habituation in chronic back pain (CBP) patients.

METHODS

A short-term habituation protocol was utilized that involved 1-sec pulses (×10) at 105% heat pain threshold on the anterior forearm at 0.5 Hz. Cardiopulmonary baroreceptor unloading was performed via lower body negative pressure (LBNP) that reduces central venous pressure to elicit a reflex increase in sympathetic nerve activity.

RESULTS

Short-term habituation was observed in young, healthy participants ( = 11), as indicated by a reduction in subjective pain ratings across the 10 repetitive heat pulses (-42% ± 29, < 0.01, = 11). Short-term habituation was also observed in CBP patients (-32% ± 30, < 0.01, = 12). Cardiopulmonary baroreceptor unloading via LBNP significantly reduced pain ratings across the 10 repetitive heat pulses in CBP patients compared with supine control (patient positioned in LBNP chamber but without a reduction in pressure) and upright sitting (chair), as indicated by a more negative area under the curve index (LBNP: -16.3 ± 4.1; Control: -14.4 ± 2.6; Upright sitting: -15.1 ± 4.1, = 0.02). However, LBNP-mediated reductions in pain ratings were selective to CBP patients with more severe symptoms, i.e., neuropathic pain (LBNP: -14.7 ± 2.1; Control: -12.8 ± 1.4; Upright sitting: -12.1 ± 1.2, = 0.04), whereas no effect of LBNP was observed in young, healthy participants ( = 0.83). In support, CBP patients with neuropathic pain exhibited significantly elevated mechanical pressure pain threshold during LBNP ( = 0.04).

CONCLUSIONS

Together, these findings demonstrate an association between cardiopulmonary baroreceptor unloading and a reduction in pain perception during repetitive noxious stimuli in CBP patients, particularly among CBP patients with greater pain severity.

摘要

引言

在研究过程中，持续的有害刺激后疼痛感知降低（短期习惯化）被认为部分由下行抑制机制介导，尽管这些机制尚未完全阐明。我们检验了心肺压力感受器会显著增加慢性背痛（CBP）患者短期习惯化的假设。

方法

采用短期习惯化方案，涉及在前臂以0.5Hz频率施加105%热痛阈值的1秒脉冲（×10次）。通过下体负压（LBNP）进行心肺压力感受器卸载，下体负压可降低中心静脉压以引发交感神经活动的反射性增加。

结果

在年轻健康参与者（n = 11）中观察到短期习惯化，这表现为在10次重复热脉冲过程中主观疼痛评分降低（-42%±29，P < 0.01，n = 11）。在CBP患者中也观察到短期习惯化（-32%±30，P < 0.01，n = 12）。与仰卧位对照（患者位于LBNP舱但压力未降低）和直立坐姿（椅子）相比，通过LBNP进行心肺压力感受器卸载显著降低了CBP患者在10次重复热脉冲过程中的疼痛评分，曲线下面积指数更负表明了这一点（LBNP：-16.3±4.1；对照：-14.4±2.6；直立坐姿：-15.1±4.1，P = 0.02）。然而，LBNP介导的疼痛评分降低对症状更严重的CBP患者具有选择性，即神经性疼痛患者（LBNP：-14.7±2.1；对照：-12.8±1.4；直立坐姿：-12.1±1.2，P =

0.04），而在年轻健康参与者中未观察到LBNP的作用（P = 0.83）。作为支持，患有神经性疼痛的CBP患者在LBNP期间机械性压痛阈值显著升高（P = 0.04）。