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

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Technical Report

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Uniformed Services University Of The Health Sciences Bethesda United States

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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 perceptioninhibition 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 OR8.59, 95 CI4.00-18.48 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 p0.097, OR1.05, 95CI0.99-1.11. The five factors as a block were predictive of exercise-angina p0.001 adjusting for covariates. In this model, only history of angina OR7.10, 95 CI3.09-16.30 was independently predictive of angina. The interaction of depressive symptoms and hot pain threshold was marginally significant p0.054 such that exercise-angina as more prevalent in individuals with lower pain thresholds and more depressive symptoms

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