Cardiopulmonary baroreceptors modify pain intensity in patients with chronic back pain

OBJECTIVE: Baroreceptors play a significant role in nociceptive pain. However, the extent to which baroreceptors modulate nociception in patients with chronic pain is unclear. We tested the hypothesis that cardiopulmonary baroreceptor unloading via LBNP would significantly increase pressure pain threshold and habituation to heat pain among patients with chronic back pain. METHODS: Mechanical pressure pain threshold at the upper trapezius (hand-held algometer) and habituation to heat pain at the forearm were performed during sitting and supine position, and during baroreceptor unloading via lower body negative pressure (LBNP) of −10 mmHg in 12 patients with chronic back pain (54 ± 11 years of age). To determine whether pain reduction is normal during LBNP, studies were repeated in 7 young, healthy participants (23 ± 7). RESULTS: Mechanical pressure pain threshold (P < 0.01) and habituation to heat pain (P = 0.04) were significantly reduced during supine compared with sitting. Conversely, baroreceptor unloading via LBNP significantly increased pressure pain threshold (P = 0.03) and heat pain habituation (P < 0.01) compared with supine. In young healthy controls, pressure pain threshold was similarly affected when comparing sitting and supine (P = 0.01) and during LBNP (P < 0.01), whereas habituation to heat pain was unaltered when comparing sitting and supine (P = 0.93) and during LBNP (P = 0.90). Total peripheral resistance was increased during LBNP (P = 0.01) but not among young, healthy controls (P = 0.71). CONCLUSIONS: The findings demonstrate cardiopulmonary baroreceptor modulation of nociceptive pain in patients with chronic pain. Interestingly, habituation to heat pain appears more readily modified by cardiopulmonary baroreceptors in patients with chronic back pain compared with young, healthy individuals.