Article Data

  • Views 468
  • Dowloads 44

Original Research

Open Access

Effect of Propranolol on Hypertonic Saline-Evoked Masseter Muscle Pain and Autonomic Response in Healthy Women During Rest and Mental Arithmetic Task

  • Karina Haugaard Bendixen1,*,
  • Astrid Juhl Terkelsen2,3
  • Lene Baad-Hansen1
  • Brian E. Cairns4
  • Peter Svensson1,5,6

1Aarhus Univ, Sect Clin Oral Physiol, Dept Dent, DK-8000 Aarhus C, Denmark

2Aarhus Univ Hosp, Danish Pain Res Ctr, DK-8000 Aarhus, Denmark

3Aarhus Univ Hosp, Dept Neurol, DK-8000 Aarhus, Denmark

4Univ British Columbia, Fac Pharmaceut Sci, Vancouver, BC, Canada

5Aarhus Univ Hosp, CFIN, DK-8000 Aarhus, Denmark

6Aarhus Univ Hosp, Dept Oral Maxillofacial Surg, DK-8000 Aarhus, Denmark

DOI: 10.11607/jop.1013 Vol.27,Issue 3,September 2013 pp.243-255

Published: 30 September 2013

*Corresponding Author(s): Karina Haugaard Bendixen E-mail: karina.bendixen@odontologi.au.dk

Abstract

Aims: To investigate in a randomized, double-blinded, placebo controlled, crossover study the effect of a single dose of the nonselective β-adrenergic receptor antagonist propranolol (40 mg) on hypertonic saline (HS)-evoked masseter muscle pain and autonomic activity during rest and during a mental arithmetic task (Paced Auditory Serial Addition Task, PASAT). Methods: Sixteen healthy women participated in two sessions in which propranolol or placebo was administered orally prior to two 5-minute infusions (30 minutes apart) of HS in the masseter muscle. The second HS infusion was combined with PASAT. HS-evoked pain intensity was scored on a numeric rating scale (NRS, 0 to 10). Heart rate variability and hemodynamic measures were recorded noninvasively (Task Force Monitor). Data were analyzed with repeated measurements analysis of variance (ANOVA). Results: Propranolol did not reduce NRS pain scores compared with placebo but did induce significant autonomic changes with reduced heart rate and increased heart rate variability (standard deviations of all normal RR intervals; root mean square successive differences; low-frequency power; high-frequency power; and total power) independent of the mental task. Conclusion: A single dose of propranolol had no effect on acute HS-evoked pain levels during rest or during mental arousal. However, it influenced the tone of the autonomic nervous system, possibly reflecting an anxiolytic effect.


Keywords

autonomic nervous system; experimental muscle pain; mental arithmetic task; propranolol; trigeminal nociceptio


Cite and Share

Karina Haugaard Bendixen,Astrid Juhl Terkelsen,Lene Baad-Hansen,Brian E. Cairns,Peter Svensson. Effect of Propranolol on Hypertonic Saline-Evoked Masseter Muscle Pain and Autonomic Response in Healthy Women During Rest and Mental Arithmetic Task. Journal of Oral & Facial Pain and Headache. 2013. 27(3);243-255.

References

1. Janig W. Systemic and specific autonomic reactions in pain: Efferent, afferent and endocrine components. Eur J anaesthesiol 1985;2:319–346.

2. Torpy DJ, Papanicolaou Da, Lotsikas aJ, Wilder rL, chrousos GP, Pillemer Sr. responses of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis to interleukin-6: a pilot study in fibromyalgia. arthritis rheum 2000;43:872–880.

3. Evaskus DS, Laskin DM. a biochemical measure of stress in patients with myofascial pain-dysfunction syndrome. J Dent res 1972;51:1464–1466.

4. Dao TT, Leresche L. Gender differences in pain. J Orofac Pain 2000;14:169–184; discussion 184–195.

5. Diatchenko L, Slade GD, nackley aG, et al. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet 2005; 14:135–143.

6. nackley aG, Tan KS, fecho K, flood P, Diatchenko L, Maixner W. catechol-O-methyltransferase inhibition increases pain sensitivity through activation of both beta2- and beta3-adrenergic receptors. Pain 2007;128:199–208.

7. Marbach JJ, Levitt M. Erythrocyte catechol-O-methyltrans- ferase activity in facial pain patients. J Dent res 1976;55:711.

8. Light Kc, Bragdon EE, Grewen KM, Brownley Ka, Girdler SS, Maixner W. adrenergic dysregulation and pain with and without acute beta-blockade in women with fibromyalgia and temporomandibular disorder. J Pain 2009;10:542–552.

9. Eze-nliam cM, Quartana PJ, Quain aM, Smith MT. nocturnal heart rate variability is lower in temporomandibular disorder patients than in healthy, pain-free individuals. J Orofac Pain 2011;25:232–239.

10. Maixner W, Greenspan JD, Dubner r, et al. Potential auto-nomic risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPEra case-control study. J Pain 2011;12(11 suppl):T75–91.

11. Tchivileva iE, Lim Pf, Smith SB, et al. Effect of catechol-O- methyltransferase polymorphism on response to propranolol therapy in chronic musculoskeletal pain: a randomized, double-blind, placebo-controlled, crossover pilot study. Pharmacogenet Genomics 2010;20:239–248.

12. Granville-Grossman KL, Turner P. The effect of propranolol on anxiety. Lancet 1966;1:788–790.

13. Koella WP. cnS-related (side-)effects of beta-blockers with special reference to mechanisms of action. Eur J clin Pharmacol 1985;28(suppl):55–63.

14. Gleiter cH, Deckert J. adverse cnS-effects of beta-adreno-ceptor blockers. Pharmacopsychiatry 1996;29:201–211.

15. Wang DW, Mistry aM, Kahlig KM, Kearney Ja, Xiang J, George aL Jr. Propranolol blocks cardiac and neuronal volt- age-gated sodium channels. front Pharmacol 2010;1:144.

16. Ernberg M, Lundeberg T, Kopp S. Effect of propranolol and granisetron on experimentally induced pain and allodynia/ hyperalgesia by intramuscular injection of serotonin into the human masseter muscle. Pain 2000;84:339–346.

17. Stohler cS, Lund JP. Psychophysical and orofacial motor response to muscle pain—Validation and utility of an experimental model. in: Morimoto T, Matsuya T, Takada K (eds). Brain and Oral functions, Oral Motor function and Dysfunction, Selected Papers from the Osaka international Oral Physiology Symposium on Brain and Oral function. Osaka, September 3–5, 1994. amsterdam/Oxford: Elsevier, 1995:227–237.

18. Svensson P, Graven-nielsen T. craniofacial muscle pain: review of mechanisms and clinical manifestations. J Orofac Pain 2001;15:117–145.

19. Bendixen KH, Baad-Hansen L, cairns BE, Svensson P. Effects of low-dose intramuscular ketorolac on experimental pain in the masseter muscle of healthy women. J Orofac Pain 2010;24:398–407.

20. Bendixen KH, Terkelsen aJ, Baad-Hansen L, cairns BE, Svensson P. Experimental stressors alter hypertonic saline- evoked masseter muscle pain and autonomic response. J Orofac Pain 2012;26:191–205.

21. Svensson P. Effects of human jaw-muscle pain on somatosensory and motor function: Experimental studies and clinical implications. aarhus: Dr Odont thesis, aarhus University, 2000.

22. cairns BE. Physiological properties of thin-fiber muscle afferents: Excitation and modulatory effects. in: Graven-niel- sen T, arendt-nielsen L, Mense S (eds). fundamentals of Musculoskeletal Pain. Seattle: iaSP Press, 2008:19–31.

23. Terkelsen aJ, Molgaard H, Hansen J, finnerup nB, Kroner K, Jensen TS. Heart rate variability in complex region- al pain syndrome during rest and mental and orthostatic stress. anesthesiology 2012;116:133–146.

24. Dworkin Sf,Leresche L.researchdiagnosticcriteriafortem- poromandibular disorders: review, criteria, examinations and specifications, critique. J craniomandib Disord 1992; 6:301–355.

25. cairns BE, Svensson P, Wang K, et al. Ketamine attenuates glutamate-induced mechanical sensitization of the masseter muscle in human males. Exp Brain res 2006;169:467–472.

26. Gronwall D, Wrightson P. Delayed recovery of intellectual function after minor head injury. Lancet 1974;2:605–609.

27. Terkelsen aJ, andersen OK, Molgaard H, Hansen J, Jensen TS. Mental stress inhibits pain perception and heart rate variability but not a nociceptive withdrawal reflex. acta Physiol Scand 2004;180:405–414.

28. Baad-Hansen L, Poulsen Hf, Jensen HM, Svensson P. Lack of sex differences in modulation of experimental intraoral pain by diffuse noxious inhibitory controls (Dnic). Pain 2005;116:359–365.

29. futarmal S, Kothari M, ayesh E, Baad-Hansen L, Svensson

P. new palpometer with implications for assessment of deep pain sensitivity. J Dent res 2011;90:918–922.

30. Svensson P, Graven-nielsen T, arendt-nielsen L. Mechanical hyperesthesia of human facial skin induced by tonic painful stimulation of jaw muscles. Pain 1998;74:93–100.

31. Thygesen TH, norholt SE, Jensen J, Svensson P. Spatial and temporal assessment of orofacial somatosensory sensitivity: a methodological study. J Orofac Pain 2007;21:19–28.

32. fortin J, Habenbacher W, Heller a, et al. non-invasive beat- to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement. comput Biol Med 2006;36:1185–1203.

33. Pan J, Tompkins WJ. a real-time QrS detection algorithm. iEEE Trans Biomed Eng 1985;32:230–236.

34. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Task force of the European Society of cardiology and the north american Society of Pacing and Electrophysiology. circulation 1996; 93:1043–1065.

35. Baker JG, Hill SJ, Summers rJ. Evolution of beta-block- ers: from antianginal drugs to ligand-directed signalling. Trends Pharmacol Sci 2011;32:227–234.

36. Turner P. Therapeutic uses of beta-adrenoceptor blocking drugs in the central nervous system in man. Postgrad Med J 1989;65:1–6.

37. Woosley rL, Kornhauser D, Smith r, et al. Suppression of chronic ventricular arrhythmias with propranolol. circulation 1979;60:819–827.

38. Kirchner a, Birklein f, Stefan H, Handwerker HO. Left vagus nerve stimulation suppresses experimentally induced pain. neurology 2000;55:1167–1171.

39. chandler MJ, Hobbs Sf, Bolser Dc, foreman rD. Effects of vagal afferent stimulation on cervical spinothalamic tract neurons in monkeys. Pain 1991;44:81–87.

40. Khasar SG, Miao fJ, Janig W, Levine JD. Vagotomy-induced enhancement of mechanical hyperalgesia in the rat is sympathoadrenal-mediated. J neurosci 1998;18:3043–3049.

41. Weissman-fogel i, Dashkovsky a, rogowski Z, Yarnitsky D. Vagal damage enhances polyneuropathy pain: additive effect of two algogenic mechanisms. Pain 2008;138:153–162.

42. Maixner W, randich a. role of the right vagal nerve trunk in antinociception. Brain res 1984;298:374–377.

43. randich a, Maixner W. interactions between cardiovascular and pain regulatory systems. neurosci Biobehav rev 1984;8:343–367.

44. Zamir n, Maixner W. The relationship between cardio-vascular and pain regulatory systems. ann n Y acad Sci 1986;467:371–384.

45. Benarroch EE. The arterial baroreflex: functional organization and involvement in neurologic disease. neurology 2008;71:1733–1738.

46. La rovere MT, Pinna GD, raczak G. Baroreflex sensitivity: Measurement and clinical implications. ann noninvasive Electrocardiol 2008;13:191–207.

47. Winzer a, ring c, carroll D, Willemsen G, Drayson M, Kendall M. Secretory immunoglobulin a and cardiovascular reactions to mental arithmetic, cold pressor, and exercise: Effects of beta-adrenergic blockade. Psychophysiology 1999;36:591–601.

48. Tousignant-Laflamme Y, rainville P, Marchand S. Establishing a link between heart rate and pain in healthy subjects: a gender effect. J Pain 2005;6:341–347.

49. Tousignant-Laflamme Y, Marchand S. Sex differences in cardiac and autonomic response to clinical and experimental pain in LBP patients. Eur J Pain 2006;10:603–614.

50. cairns BE, Gazerani P. Sex-related differences in pain. Maturitas 2009;63:292–296.

51. Popescu a, Leresche L, Truelove EL, Drangsholt MT. Gender differences in pain modulation by diffuse noxious inhibi- tory controls: a systematic review. Pain 2010;150:309–318.

52. isselee H, De Laat a, De Mot B, Lysens r. Pressure-pain threshold variation in temporomandibular disorder myalgia over the course of the menstrual cycle. J Orofac Pain 2002; 16:105–117.

53. Hayano J, Yamada M, Sakakibara Y, et al. Short- and long- term effects of cigarette smoking on heart rate variability. am J cardiol 1990;65:84–88.

54. Villemure c, Slotnick BM, Bushnell Mc. Effects of odors on pain perception: Deciphering the roles of emotion and attention. Pain 2003;106:101–108.

55. Moont r, Pud D, Sprecher E, Sharvit G, Yarnitsky D. ‘Pain inhibits pain’ mechanisms: is pain modulation simply due to distraction? Pain 2010;150:113–120.

56. arendt-nielsen L, Graven-nielsen T. Translational musculoskeletal pain research. Best Pract res clin rheumatol 2011;25:209–226.


Abstracted / indexed in

Science Citation Index (SCI)

Science Citation Index Expanded (SCIE)

BIOSIS Previews

Scopus

Cumulative Index to Nursing and Allied Health Literature (CINAHL)

Submission Turnaround Time

Conferences

Top