The Neuromatrix Theory of Pain and Angina during Exercise Stress Testing: Results from the PIMI Study

Background: The Neuromatrix Theory of pain (Melzack, 1999) describes five factors (cognitive-sensory, affective-emotional, nociception, inhibitory, and CNS modulation) that operate to modulate pain. This study assesses the interplay among these factors in the development of exercise-induced anginal...

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Bibliographic Details
Main Author: Bekkouche,Nadine S
Format: Report
Language:English
Subjects:
angina
depression
depressive disorder
emotion
hypertension
ischemia
neuromatrix theory
pain
patients
stress (physiology)
theses
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Summary:Background: The Neuromatrix Theory of pain (Melzack, 1999) describes five factors (cognitive-sensory, affective-emotional, nociception, inhibitory, and CNS modulation) that operate to modulate pain. This study assesses the interplay among these factors in the development of exercise-induced anginal pain. Methods: Participants were 175 patients (26 women) with documented CAD and a positive bicycle exercise stress test from the National Heart, Lung, and Blood Institute (NHLBI) Psychophysiological Investigations of Myocardial Ischemia (PIMI) study. Of these, 62 patients reported angina during testing. Patients completed the Rose Angina Questionnaire (cognitive sensory measure), the Beck Depression Inventory (affective-emotional measure), a thermal pain threshold test (nociception), the modified Autonomic Perception Questionnaire (symptom perception/inhibition measure). Plasma -endorphin levels (opioid modulation) were also assessed at rest and at peak exercise stress. We assessed main effects and interactions among the five factors. Results: Logistic regression examining the five factors of the Neuromatrix model revealed that only history of angina predicted exercise-induced angina (OR=8.59, 95% CI=4.00-18.48) when adjusting for age, sex, history of diabetes, history of hypertension, history of myocardial infarction and maximum ST-segment depression during ischemia. Without adjusting for covariates,depressive symptoms marginally predicted exercise-angina (p=0.097, OR=1.05, 95%CI=0.99-1.11). The five factors as a block were predictive of exercise-angina (p0.001) adjusting for covariates. In this model, only history of angina (OR=7.10, 95% CI=3.09-16.30) was independently predictive of angina. The interaction of depressive symptoms and hot pain threshold was marginally significant (p=0.054) such that exercise-angina as more prevalent in individuals with lower pain thresholds and more depressive symptoms