title: Effects of opioid blockade with naltrexone and distraction on cold and ischemic pain in hypertension.
abstract: Essential hypertension is characterised by reduced pain sensitivity. Hypertensive hypoalgesia has been attributed to elevated endogenous opioids and/or increased activation of descending pain modulation systems. A double-blind placebo-controlled design compared the effects of naltrexone and placebo on cold and ischemic pain in unmedicated newly-diagnosed patients with essential hypertension. Patients performed a cold pressor task while resting and while performing a distracting secondary task. They also performed a forearm ischemia task while resting. Although the cold pressor and ischemia tasks elicited significant increases in pain and blood pressure, pain ratings and pressor responses did not differ between naltrexone and placebo. Cold pain was reduced by distraction compared to rest. The finding that opioid blockade with naltrexone did not moderate the pain and pressor responses to cold and ischemia suggests that pain and associated blood pressure responses are not modulated by opioids in hypertension. The finding that the distracting secondary task successfully reduced pain ratings suggests normal supraspinal pain modulation in essential hypertension.
authors.affiliation: International Centre for Health and Exercise Research, University of Birmingham, Birmingham, B15 2TT, UK. c.m.ring@bham.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Ring
authors.forename: Christopher R
authors.initials: CR
authors.lastname: France
authors.forename: Mustafa
authors.initials: M
authors.lastname: al'Absi
authors.forename: Louise
authors.initials: L
authors.lastname: Beesley
authors.forename: Louisa
authors.initials: L
authors.lastname: Edwards
authors.forename: David
authors.initials: D
authors.lastname: McIntyre
authors.forename: Douglas
authors.initials: D
authors.lastname: Carroll
authors.forename: Una
authors.initials: U
authors.lastname: Martin
mesh_terms: D000328:Adult; D001288:Attention; D003080:Cold Temperature; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000378:metabolism*; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000378:metabolism*; D009271:Naltrexone / Q000008:administration & dosage / Q000494:pharmacology*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D010147:Pain Measurement; D014110:Touch; D001615:beta-Endorphin / Q000037:antagonists & inhibitors* / Q000378:metabolism*
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone; D001615:beta-Endorphin