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Volume 15 Issue 2
Mar.  2024
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CUI Quexuan, CHE Lu, XU Li. Baroreflex in Pain Regulation: Pathogenic Mechanism and Clinical Application[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 258-264. DOI: 10.12290/xhyxzz.2023-0552
Citation: CUI Quexuan, CHE Lu, XU Li. Baroreflex in Pain Regulation: Pathogenic Mechanism and Clinical Application[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 258-264. DOI: 10.12290/xhyxzz.2023-0552
shu

Baroreflex in Pain Regulation: Pathogenic Mechanism and Clinical Application

  • Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds: 

National High Level Hospital Clinical Research Funding 2022-PUMCH-B-119

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  • Corresponding author:

    XU Li, E-mail: pumchxuli@163.com

  • Received Date: November 19, 2023
  • Accepted Date: December 17, 2023
  • Available Online: December 21, 2023
  • Issue Publish Date: March 29, 2024
    Graphical Abstract
    • Abstract
  • The baroreceptor reflex is an essential mechanism for the autonomic nervous system in cardiovascular homeostasis and is closely related to pain regulation. Baroreflex sensitivity (BRS) is an indicator for quantitative evaluation of baroreflex reflex function. Pain sensitivity is negatively correlated with BRS, therefore, BRS has potential application prospects in pain risk prediction and therapeutic efficacy assessment. Vagus nerve stimulation, capable of activating the baroreceptor reflex, has been widely used in acute or chronic pain patients in recent years. This article reviews the mechanism and clinical application progress of the baroreceptor reflex in pain regulation, with the hope of providing reference for further exploring treatment to regulate baroreceptor reflex function in pain treatment.
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    • References (64)
  • [1]
    Bantel C, Trapp S. The role of the autonomic nervous system in acute surgical pain processing-what do we know?[J]. Anaesthesia, 2011, 66(7): 541-544. DOI: 10.1111/j.1365-2044.2011.06791.x
    [2]
    Giannoni A, Gentile F, Buoncristiani F, et al. Chemoreflex and baroreflex sensitivity hold a strong prognostic value in chronic heart failure[J]. JACC Heart Fail, 2022, 10(9): 662-676. DOI: 10.1016/j.jchf.2022.02.006
    [3]
    Kaufmann D K, Raczak G, Szwoch M, et al. Baroreflex sensitivity but not microvolt T-wave alternans can predict major adverse cardiac events in ischemic heart failure[J]. Cardiol J, 2022, 29(6): 1004-1012. DOI: 10.5603/CJ.a2020.0129
    [4]
    Davydov D M, Naliboff B, Shahabi L, et al. Asymmetries in reciprocal baroreflex mechanisms and chronic pain severity: focusing on irritable bowel syndrome[J]. Neurogastroen-terol Motil, 2018, 30(2): e13186. DOI: 10.1111/nmo.13186
    [5]
    Reyes Del Paso G A, Contreras-Merino A M, De La Coba P, et al. The cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia: associations with pain, affective impairments, sleep problems, and fatigue[J]. Psychophysiology, 2021, 58(5): e13800. DOI: 10.1111/psyp.13800
    [6]
    Yuan H, Silberstein S D. Vagus nerve and vagus nerve stimulation, a comprehensive review: part Ⅲ[J]. Headache, 2016, 56(3): 479-490. DOI: 10.1111/head.12649
    [7]
    Koopman F A, Chavan S S, Miljko S, et al. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis[J]. Proc Natl Acad Sci U S A, 2016, 113(29): 8284-8289. DOI: 10.1073/pnas.1605635113
    [8]
    Aranow C, Atish-Fregoso Y, Lesser M, et al. Transcutane-ous auricular vagus nerve stimulation reduces pain and fatigue in patients with systemic lupus erythematosus: a randomised, double-blind, sham-controlled pilot trial[J]. Ann Rheum Dis, 2021, 80(2): 203-208. DOI: 10.1136/annrheumdis-2020-217872
    [9]
    Patel A B U, Bibawy P P W M, Althonayan J I M, et al. Effect of transauricular nerve stimulation on perioperative pain: a single-blind, analyser-masked, randomised control-led trial[J]. Br J Anaesth, 2023, 130(4): 468-476. DOI: 10.1016/j.bja.2022.12.025
    [10]
    Rabinovitch A, Friedman M, Braunstein D, et al. The baroreflex mechanism revisited[J]. Bull Math Biol, 2015, 77(8): 1521-1538. DOI: 10.1007/s11538-015-0094-4
    [11]
    Saper C B. The central autonomic nervous system: conscious visceral perception and autonomic pattern generation[J]. Annu Rev Neurosci, 2002, 25: 433-469. DOI: 10.1146/annurev.neuro.25.032502.111311
    [12]
    Weston M, Wang H, Stornetta R L, et al. Fos expression by glutamatergic neurons of the solitary tract nucleus after phenylephrine-induced hypertension in rats[J]. J Comp Neurol, 2003, 460(4): 525-541. DOI: 10.1002/cne.10663
    [13]
    Beckers A B, Van Oudenhove L, Weerts Z Z R M, et al. Evidence for engagement of the nucleus of the solitary tract in processing intestinal chemonociceptive input irrespective of conscious pain response in healthy humans[J]. Pain, 2022, 163(8): 1520-1529. DOI: 10.1097/j.pain.0000000000002538
    [14]
    Benarroch E E. Pain-autonomic interactions[J]. Neurol Sci, 2006, 27(Suppl 2): S130-S133.
    [15]
    He S L, Huang X L, Zheng J, et al. An NTS-CeA projection modulates depression-like behaviors in a mouse model of chronic pain[J]. Neurobiol Dis, 2022, 174: 105893. DOI: 10.1016/j.nbd.2022.105893
    [16]
    Marques-Lopes J, Pinto M, Pinho D, et al. Microinjec-tion of angiotensin Ⅱ in the caudal ventrolateral medulla induces hyperalgesia[J]. Neuroscience, 2009, 158(4): 1301-1310. DOI: 10.1016/j.neuroscience.2008.11.044
    [17]
    Gu X L, Zhang Y Z, O'Malley J J, et al. Neurons in the caudal ventrolateral medulla mediate descending pain control[J]. Nat Neurosci, 2023, 26(4): 594-605. DOI: 10.1038/s41593-023-01268-w
    [18]
    Babic T, Ciriello J. Medullary and spinal cord projections from cardiovascular responsive sites in the rostral ventro-medial medulla[J]. J Comp Neurol, 2004, 469(3): 391-412. DOI: 10.1002/cne.11024
    [19]
    Eckberg D L, Drabinsky M, Braunwald E. Defective cardiac parasympathetic control in patients with heart disease[J]. N Engl J Med, 1971, 285(16): 877-883. DOI: 10.1056/NEJM197110142851602
    [20]
    Raczak G, La Rovere M T, Pinna G D, et al. Assessment of baroreflex sensitivity in patients with preserved and impaired left ventricular function by means of the Valsalva manoeuvre and the phenylephrine test[J]. Clin Sci (Lond), 2001, 100(1): 33-41. DOI: 10.1042/cs1000033
    [21]
    Bernardi L, Bianchini B, Spadacini G, et al. Demonstrable cardiac reinnervation after human heart transplantation by carotid baroreflex modulation of RR interval[J]. Circulation, 1995, 92(10): 2895-2903. DOI: 10.1161/01.CIR.92.10.2895
    [22]
    La Rovere M T, Specchia G, Mortara A, et al. Barore-flex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction. A prospective study[J]. Circulation, 1988, 78(4): 816-824. DOI: 10.1161/01.CIR.78.4.816
    [23]
    Petry D, Mirian De Godoy Marques C, Brum Marques J L. Baroreflex sensitivity with different lags and random forests for staging cardiovascular autonomic neuropathy in subjects with diabetes[J]. Comput Biol Med, 2020, 127: 104098. DOI: 10.1016/j.compbiomed.2020.104098
    [24]
    Madden K M, Feldman B, Meneilly G S. Baroreflex function and postprandial hypotension in older adults[J]. Clin Auton Res, 2021, 31(2): 273-280. DOI: 10.1007/s10286-020-00671-8
    [25]
    Hartikainen J E, Tahvanainen K U, Mäntysaari M J, et al. Simultaneous invasive and noninvasive evaluations of baroreflex sensitivity with bolus phenylephrine technique[J]. Am Heart J, 1995, 130(2): 296-301. DOI: 10.1016/0002-8703(95)90443-3
    [26]
    Thieme K, Jung K, Mathys M G, et al. Cardiac-gated neuromodulation increased baroreflex sensitivity and reduced pain sensitivity in female fibromyalgia patients[J]. J Clin Med, 2022, 11(20): 6220. DOI: 10.3390/jcm11206220
    [27]
    Ghione S, Rosa C, Mezzasalma L, et al. Arterial hyperten-sion is associated with hypalgesia in humans[J]. Hypertension, 1988, 12(5): 491-497. DOI: 10.1161/01.HYP.12.5.491
    [28]
    Nascimento Rebelatto M, Alburquerque-Sendín F, Guimarães J F, et al. Pressure pain threshold is higher in hypertensive compared with normotensive older adults: a case-control study[J]. Geriatr Gerontol Int, 2017, 17(6): 967-972. DOI: 10.1111/ggi.12824
    [29]
    Bruehl S, Burns J W, Chung O Y, et al. Hypoalgesia associated with elevated resting blood pressure: evidence for endogenous opioid involvement[J]. J Behav Med, 2010, 33(2): 168-176. DOI: 10.1007/s10865-009-9241-4
    [30]
    Bruehl S, Carlson C R, McCubbin J A. The relationship between pain sensitivity and blood pressure in normotensives[J]. Pain, 1992, 48(3): 463-467. DOI: 10.1016/0304-3959(92)90099-W
    [31]
    Randich A, Robertson J D. Spinal nociceptive transmission in the spontaneously hypertensive and Wistar-Kyoto normotensive rat[J]. Pain, 1994, 58(2): 169-183. DOI: 10.1016/0304-3959(94)90197-X
    [32]
    Zamir N, Segal M. Hypertension-induced analgesia: changes in pain sensitivity in experimental hypertensive rats[J]. Brain Res, 1979, 160(1): 170-173. DOI: 10.1016/0006-8993(79)90614-0
    [33]
    Duschek S, Mück I, Reyes Del Paso G A. Relationship between baroreceptor cardiac reflex sensitivity and pain experience in normotensive individuals[J]. Int J Psychophysiol, 2007, 65(3): 193-200. DOI: 10.1016/j.ijpsycho.2007.03.012
    [34]
    Chung O Y, Bruehl S, Diedrich L, et al. The impact of blood pressure and baroreflex sensitivity on wind-up[J]. Anesth Analg, 2008, 107(3): 1018-1025. DOI: 10.1213/ane.0b013e31817f8dfe
    [35]
    Bruehl S, Chung O Y, 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[J]. Pain, 2002, 100(1/2): 191-201.
    [36]
    Maixner W, Greenspan J D, Dubner R, et al. Potential autonomic risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study[J]. J Pain, 2011, 12(11 Suppl): T75-T91.
    [37]
    Reyes Del Paso G A, Garrido S, Pulgar Á, et al. Autonomic cardiovascular control and responses to experimental pain stimulation in fibromyalgia syndrome[J]. J Psychosom Res, 2011, 70(2): 125-134. DOI: 10.1016/j.jpsychores.2010.09.012
    [38]
    Zamunér A R, Barbic F, Dipaola F, et al. Relationship between sympathetic activity and pain intensity in fibromyalgia[J]. Clin Exp Rheumatol, 2015, 33(1 Suppl 88): S53-S57.
    [39]
    Light K C, Bragdon E E, Grewen K M, et al. Adrenergic dysregulation and pain with and without acute beta-blockade in women with fibromyalgia and temporomandibular disorder[J]. J Pain, 2009, 10(5): 542-552. DOI: 10.1016/j.jpain.2008.12.006
    [40]
    Brognara F, Castania J A, Kanashiro A, et al. Physiological sympathetic activation reduces systemic inflammation: role of baroreflex and chemoreflex[J]. Front Immunol, 2021, 12: 637845. DOI: 10.3389/fimmu.2021.637845
    [41]
    Koopman F A, Tang M W, Vermeij J, et al. Autonomic dysfunction precedes development of rheumatoid arthritis: a prospective cohort study[J]. EBioMedicine, 2016, 6: 231-237. DOI: 10.1016/j.ebiom.2016.02.029
    [42]
    Bernstein I M, Damron D, Schonberg A L, et al. The relationship of plasma volume, sympathetic tone, and proinflammatory cytokines in young healthy nonpregnant women[J]. Reprod Sci, 2009, 16(10): 980-985. DOI: 10.1177/1933719109338876
    [43]
    Pöyhönen-Alho M K, Manhem K, Katzman P, et al. Central sympatholytic therapy has anti-inflammatory properties in hypertensive postmenopausal women[J]. J Hypertens, 2008, 26(12): 2445-2449. DOI: 10.1097/HJH.0b013e328311cf37
    [44]
    Adlan A M, Paton J F R, Lip G Y H, et al. Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in rheumatoid arthritis[J]. J Physiol, 2017, 595(3): 967-981. DOI: 10.1113/JP272944
    [45]
    Dorantes Mendez G, Aletti F, Toschi N, et al. Baroreflex sensitivity variations in response to propofol anesthesia: comparison between normotensive and hypertensive patients[J]. J Clin Monit Comput, 2013, 27(4): 417-426. DOI: 10.1007/s10877-012-9426-1
    [46]
    臧晗, 余佳文, 车璐, 等. 自主神经功能对全身麻醉诱导后低血压的预测作用[J]. 医学研究杂志, 2023, 52(6): 190-193. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ202306038.htm

    Zang H, Yu J W, Che L, et al. The predictive effect of autonomic nervous system function on hypotension induced by general anesthesia[J]. J Med Res, 2023, 52(6): 190-193. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ202306038.htm
    [47]
    France C R, Katz J. Postsurgical pain is attenuated in men with elevated presurgical systolic blood pressure[J]. Pain Res Manag, 1999, 4: 460391.
    [48]
    Pan P H, Coghill R, Houle T T, et al. Multifactorial preoperative predictors for postcesarean section pain and analgesic requirement[J]. Anesthesiology, 2006, 104(3): 417-425. DOI: 10.1097/00000542-200603000-00007
    [49]
    Chiang H L, Huang Y C, Lin H S, et al. Hypertension and postoperative pain: a prospective observational study[J]. Pain Res Manag, 2019, 2019: 8946195.
    [50]
    Nielsen R, Nikolajsen L, Krøner K, et al. Pre-operative baroreflex sensitivity and efferent cardiac parasympathetic activity are correlated with post-operative pain[J]. Acta Anaesthesiol Scand, 2015, 59(4): 475-485. DOI: 10.1111/aas.12457
    [51]
    Suarez-Roca H, Mamoun N, Watkins L L, et al. Higher cardiovagal baroreflex sensitivity predicts increased pain outcomes after cardiothoracic surgery[J]. J Pain, 2024, 25(1): 187-201. DOI: 10.1016/j.jpain.2023.08.002
    [52]
    Zabara J. Peripheral control of hypersynchronous discharge in epilepsy[J]. Electroencephalogr Clin Neurophysiol, 1985, 61(3): S162.
    [53]
    Lange G, Janal M N, Maniker A, et al. Safety and efficacy of vagus nerve stimulation in fibromyalgia: a phase Ⅰ/Ⅱ proof of concept trial[J]. Pain Med, 2011, 12(9): 1406-1413. DOI: 10.1111/j.1526-4637.2011.01203.x
    [54]
    Kutlu N, Özden A V, Alptekin H K, et al. The impact of auricular vagus nerve stimulation on pain and life quality in patients with fibromyalgia syndrome[J]. Biomed Res Int, 2020, 2020: 8656218.
    [55]
    Drewes A M, Brock C, Rasmussen S E, et al. Short-term transcutaneous non-invasive vagus nerve stimulation may reduce disease activity and pro-inflammatory cytokines in rheumatoid arthritis: results of a pilot study[J]. Scand J Rheumatol, 2021, 50(1): 20-27. DOI: 10.1080/03009742.2020.1764617
    [56]
    Shirasaka T, Yano T, Kunitake T, et al. High-dose remifentanil increases blood pressure and heart rate mediated by sympatho-activation in conscious rats[J]. J Anesth, 2013, 27(3): 325-332. DOI: 10.1007/s00540-012-1515-2
    [57]
    Hogue C W, Jr, Talke P, Stein P K, et al. Autonomic nervous system responses during sedative infusions of dexmedetomidine[J]. Anesthesiology, 2002, 97(3): 592-598. DOI: 10.1097/00000542-200209000-00012
    [58]
    Devcic A, Schmeling W T, Kampine J P, et al. Oral dexmedetomidine preserves baroreceptor function and decreases anesthetic requirements of halothane-anesthetized dogs[J]. Anesthesiology, 1994, 81(2): 419-430. DOI: 10.1097/00000542-199408000-00021
    [59]
    Chung O Y, Bruehl S, Diedrich L, et al. Baroreflex sensitivity associated hypoalgesia in healthy states is altered by chronic pain[J]. Pain, 2008, 138(1): 87-97. DOI: 10.1016/j.pain.2007.11.011
    [60]
    Qiu H D, Sun Z, Shadhiya F, et al. The influence of dexmedetomidine on remifentanil-induced hyperalgesia and the sex differences[J]. Exp Ther Med, 2018, 16(4): 3596-3602.
    [61]
    Li Y W, Li W, Wang S T, et al. The autonomic nervous system: a potential link to the efficacy of acupuncture[J]. Front Neurosci, 2022, 16: 1038945. DOI: 10.3389/fnins.2022.1038945
    [62]
    Pang Y, Liao H, Duan G X, et al. Regulated aberrant amygdala functional connectivity in premenstrual syndrome via electro-acupuncture stimulation at Sanyinjiao acupoint (SP6)[J]. Gynecol Endocrinol, 2021, 37(4): 315-319. DOI: 10.1080/09513590.2020.1855633
    [63]
    Dhond R P, Yeh C, Park K, et al. Acupuncture modulates resting state connectivity in default and sensorimotor brain networks[J]. Pain, 2008, 136(3): 407-418. DOI: 10.1016/j.pain.2008.01.011
    [64]
    Beissner F, Deichmann R, Henke C, et al. Acupuncture-deep pain with an autonomic dimension?[J]. Neuroimage, 2012, 60(1): 653-660. DOI: 10.1016/j.neuroimage.2011.12.045
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