Increased energy expenditure and glucose oxidation during acute nontraumatic skin pain in humans.
OBJECTIVE
Tissue injury is accompanied by pain and results in increased energy expenditure, which may promote catabolism. The extent to which pain contributes to this sequence of events is not known.


METHODS
In a cross-over design, 10 healthy volunteers were examined on three occasions; first, during self-controlled nontraumatic electrical painful stimulus to the abdominal skin, maintaining an intensity of 8 on the visual analogue scale (0-10). Next, the electrical stimulus was reproduced during local analgesia and, finally, there was a control session without stimulus. Indirect calorimetry and blood and urine sampling was done in order to calculate energy expenditure and substrate utilization.


RESULTS
During pain stimulus, energy expenditure increased acutely and reversibly by 62% (95% confidence interval, 43-83), which was abolished by local analgesia. Energy expenditure paralleled both heart rate and blood catecholamine levels. The energy expenditure increase was fuelled by all energy sources, with the largest increase in glucose utilization.


CONCLUSIONS
The pain-related increase in energy expenditure was possibly mediated by adrenergic activity and was probably to a large extent due to increased muscle tone. These effects may be enhanced by cortical events related to the pain. The increase in glucose consumption favours catabolism. Our findings emphasize the clinical importance of pain management.
Holland-Fischer
Peter
P
Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Aarhus, Denmark. phf@svf.au.dk
Greisen
Jacob
J
Grøfte
Thorbjørn
T
Jensen
Troels S
TS
Hansen
Peter O
PO
Vilstrup
Hendrik
H
D000328:Adult; D002151:Calorimetry / Q000706:statistics & numerical data; D002985:Clinical Protocols; D018592:Cross-Over Studies; D004558:Electric Stimulation; D004734:Energy Metabolism / Q000502:physiology*; D004837:Epinephrine / Q000097:blood; D005947:Glucose / Q000378:metabolism; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D050356:Lipid Metabolism; D008297:Male; D009638:Norepinephrine / Q000097:blood; D010084:Oxidation-Reduction; D010146:Pain / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D011506:Proteins / Q000378:metabolism; D012871:Skin Diseases / Q000378:metabolism* / Q000503:physiopathology; D013997:Time Factors; D055815:Young Adult
D011506:Proteins; D005947:Glucose; D009638:Norepinephrine; D004837:Epinephrine