Skip to main content

Alterations in Pain Perception in Cardiovascular Disease

  • Chapter
Pathophysiology of Pain Perception

Part of the book series: Plenum Series in Rehabilitation and Health ((SSRH))

  • 342 Accesses

Abstract

Cardiovascular disease (CVD) is highly prevalent and is associated with tremendous morbidity and mortality. In the United States, nearly 62,000,000 people have some form of CVD, including hypertension, coronary heart disease, stroke, congestive heart failure and congenital cardiovascular defects. CVD is the number one cause of death in the United States, claiming more than 950,000 lives in 1999 (American Heart Association, 2001). The most common form of CVD is hypertension, which affects 50,000,000 Americans. While chest pain is a common accompaniment of CVD, only relatively recently have disturbances of pain perception in CVD become a topic of significant scientific interest. Over the past 25 years, interactions between the cardiovascular and somatosensory systems have become increasingly recognized, and considerable research has identified important effects of cardiovascular responses on pain perception. This chapter will summarize the literature regarding the relationship of cardiovascular factors with pain perception. First, the influence of several cardiovascular variables on pain perception will be reviewed, including resting blood pressure, parental history of hypertension, and cardiovascular reactivity. Then, potential mechanisms underlying these associations will be discussed. Next, research examining pain perception in various cardiovascular disorders will be presented, and the chapter will conclude with a discussion of clinical implications and directions for future research.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • al’Absi, M., Buchanan, T., & Lovallo, W.R. (1996). Pain perception and cardiovascular responses in men with positive parental history for hypertension. Psychopbysiology, 33, 655–661.

    Article  Google Scholar 

  • al’Absi, M., Petersen, K. L., & Wittmers, L. E. (2002). Adrenocortical and hemodynamic predictors of pain perception in men and women. Pain, 96, 197–204.

    Article  PubMed  Google Scholar 

  • American Heart Association. 2002 heart and stroke statistical update. 2001. Dallas, TX, American Heart Association.

    Google Scholar 

  • Angrilli, A., Mini, A., Mucha, R. F., & Rau, H. (1997). The influence of low blood pressure and baroreceptor activity on pain responses. Physiology and Behaviour, 62, 391–397.

    Article  Google Scholar 

  • Aronow, W. S., Ahn, C., Mercando, A. D., & Epstein, S. (2000). Prevalence of coronary artery disease, complex ventricular arrhythmias, and silent myocatdial ischemia and incidence of new coronary events in older persons with chronic renal insufficiency and with normal renal function. American Journal of Cardiology, 86, 1142–3, A9.

    Article  PubMed  Google Scholar 

  • Bardin, L., Lavarenne, J., & Eschalier, A. (2000). Serotonin receptor subtypes involved in the spinal antinociceptive effect of 5-HT in rats. Pain, 86, 11–18.

    Article  PubMed  Google Scholar 

  • Boon, D., Piek, J. J., & van Montfrans, G. A. (2000). Silent ischaemia and hypertension. Journal of Hypertension, 18, 1355–1364.

    Article  PubMed  Google Scholar 

  • Bragdon, E. E., Light, K. C., Girdler, S. S., & Maixner, W (1997). Blood pressure, gender, and parental hypertension are factors in baseline and poststress pain sensitivity in normotensive adults. International Journal of Behavioral Medicine, 4, 17–38.

    Article  PubMed  Google Scholar 

  • Caceres, C., & Burns, J. W. (1997). Cardiovascular reactivity to psychological stress may enhance subsequent pain sensitivity. Pain, 69, 237–244.

    Article  PubMed  Google Scholar 

  • D’Antono, B., Ditto, B., Rios, N., & Moskowitz, D. S. (1999). Risk for hypertension and diminished pain sensitivity in women: autonomic and daily correlates. International Journal of Psychophysiology, 31, 175–187.

    Article  PubMed  Google Scholar 

  • Davies, R. F., Linden, W., Habibi, H., Klinke, W. P., Nadeau, C., Phaneuf, D. C., Lepage, S., Dessain, P., & Buttars, J. A. (1993). Relative importance of psychologic traits and severity of ischemia in causing angina during treadmill exercise. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators. Journal of the American Collie of Cardiology, 21, 331–336.

    Article  Google Scholar 

  • Delbarre, B., Casset-Senon, D., Delbarre, G., Sestillange, P., & Christin, O. (1982). Naloxone effects on blood pressure, analgesia and diuresis in spontaneous hypertensive and normotensive rats. Neuroscience Letters, 30, 167–172.

    Article  PubMed  Google Scholar 

  • Ditto, B., Seguin, J. R., Boulerice, B., Pihl, R. O., & Tremblay, R. E. (1998). Risk for hypertension and pain sensitivity in adolescent boys. Health Psychology, 17, 249–254.

    Article  PubMed  Google Scholar 

  • Droste, C., Greenlee, M. W., Schreck, M., & Roskamm, H. (1991). Experimental pain thresholds and plasma betaendorphin levels during exercise. Medicine and Science in Sports and Exercise, 23, 334–342.

    Article  PubMed  Google Scholar 

  • Droste, C., Kardos, A., Brody, S., Greenlee, M. W., Roskamm, H., & Rau, H. (1994). Baroreceptor stimulation: pain perception and sensory thresholds. Biological Psychology, 37, 101–113.

    Article  PubMed  Google Scholar 

  • Droste, C., Meyer Blankenburg, H., Greenlee, M. W., & Roskamm, H. (1988). Effect of physical exercise on pain thresholds and plasma beta-endorphins in patients with silent and symptomatic myocardial ischaemia. European Heart Journal, 9 (Suppl.), 25–33.

    PubMed  Google Scholar 

  • Droste, C., & Roskamm, H. (1983). Experimental pain measurement in patients with asymptomatic myocardial ischemia. Journal of the American College of Cardiology, 1, 940–945.

    Article  PubMed  Google Scholar 

  • Dworkin, B. (1988). Hypertension as a learned responses: the barorecptor reinforcement hypothesis. In T. Elbert, W. Langosch, A. Steptoe, & D. Vaitl (Eds.), Behavioral Mediane in Cardiovascular Disorders (pp. 17–47). Chicester: John Wiley & Sons.

    Google Scholar 

  • Dworkin, B. R., Elbert, T., Rau, H., Birbaumer, N., Pauli, P., Droste, C., & Brunia, C. H. (1994). Central effects of baroreceptor activation in humans: attenuation of skeletal reflexes and pain perception. Proceedings of the National Academy of Sciences of the United States of America, 91, 6329–6333.

    Article  PubMed  Google Scholar 

  • Edwards, L., Ring, C., Mclntyrc, D., & Carroll, D. (2001). Modulation of the human nociceptive flexion reflex across the cardiac cycle. Psychophysiology, 38, 712–718.

    Article  PubMed  Google Scholar 

  • Elbert, T., Dworkin, B. R., Rau, H., Pauli, P., Birbaumer, N., Droste, C., & Brunia, C. H. M. (1994). Sensory effects of baroreceptor activation and perceived stress together predict long-term blood pressure elevations. International Journal of Behavioral Medicine, 1, 215–228.

    Article  PubMed  Google Scholar 

  • Elbert, T., Rockstroh, B., Lutzenberger, W., Kessler, M., & Pietrowsky, R. (1988). Baroreceptor stimulation alters pain sensation depending on tonic blood pressure. Psychophysiology, 25, 25–29.

    Article  PubMed  Google Scholar 

  • Falcone, C., Sconocchia, R., Guasti, L., Codega, S., Montemartini, C., & Specchia, G. (1988). Dental pain threshold and angina pectoris in patients with coronary artery disease. Journal of the American College of Cardiology, 12, 348–352.

    Article  PubMed  Google Scholar 

  • Fillingim, R. B., & Maixner, W. (1996). The influence of resting blood pressure and gender on pain repsonses. Psychosomatic Medicine, 58, 326–332.

    PubMed  Google Scholar 

  • France, C., Adler, P. S.J., France, J., & Ditto, B. (1994). Family history of hypertension and pain during blood donation. Psychosomatic Medicine, 56, 52–60.

    PubMed  Google Scholar 

  • France, C., Ditto, B., & Adler, P. (1991). Pain sensitivity in offspring of hypertensives at rest and during baroreflex stimulation. Journal of Behavioral Medicine, 14, 513–525.

    Article  PubMed  Google Scholar 

  • France, C. R. (1999). Decreased pain perception and risk for hypertension: considering a common physiological mechanism. Psychophysiology, 36, 683–692.

    Article  PubMed  Google Scholar 

  • France, C. R., French, D. J., Page, G. D., Bonk, V. A., Meade, M. A., Stewart, K. M., & Holroyd, K. A. (1996). Exteroceptive suppression of temporalis and masseter muscle activity is enhanced in offspring of hypertensives. Psychophysiology, 33, 601–604.

    Article  PubMed  Google Scholar 

  • France, C. R., & Stewart, K. M. (1995). Parental history of hypertension and enhanced cardiovascular reactivity are associated with decreased pain ratings. Psychophysiology, 32, 571–578.

    Article  PubMed  Google Scholar 

  • Freedland, K. E., Carney, R. M., Krone, R.J., Case, N.B., & Case, R. B. (1996). Psychological determinants of anginal pain perception during exercise testing of stable patients after recovery from acute myocardial infarction or unstable angina pectoris. American Journal of Cardiology, 77, 1–4.

    Article  PubMed  Google Scholar 

  • Freedland, K. E., Carney, R. M., Krone, R. J., Smith, L. J., Rich, M. W., Eisenkramer, G., & Fischer, K. C. (1991). Psychological factors in silent myocardial ischemia. Psychosomatic Medicine, 53, 13–24.

    PubMed  Google Scholar 

  • Ghione, S. (1996). Hypertension-associated hypalgesia. Evidence in experimental animals and humans, pathophysiological mechanisms, and potential clinical consequences. Hypertension, 28, 494–504.

    Article  PubMed  Google Scholar 

  • Ghione, S., Rosa, C., Mezzasalma, L., & Panattoni, E. (1988). Arterial hypertension is associated with hypalgesia in humans. Hypertension, 12, 491–497.

    Article  PubMed  Google Scholar 

  • Giagnoni, E., Secchi, M. B., Wu, S. C., Morabito, A., Oltrona, L., Mancarella, S., Volpin, N., Fossa, L., Bettazzi, L., & Arangio, G. (1983). Prognostic value of exercise EKG testing in asymptomatic normotensive subjects. A prospective matched study. The New England Journal of Medicine, 309, 1085–1089.

    Article  PubMed  Google Scholar 

  • Glusman, M., Coromilas, J., Clark, W. C., Janal, M. N., Blood, D. K., Kuhl, J. P., & Burns, K. (1996). Pain sensitivity in silent myocardial ischemia. Pain, 64, 477–483.

    Article  PubMed  Google Scholar 

  • Go, B. M., Sheffield, D., Krittayaphong, R., Maixner, W., & Sheps, D. S. (1997). Association of systolic blood pressure at time of myocardial ischemia with angina pectoris during exercise testing. American Journal of Cardiology, 79, 954–956.

    Article  PubMed  Google Scholar 

  • Guasti, L., Cattaneo, R., Daneri, A., Bianchi, L., Gaudio, G., Regazzi, M. B., Gfandi, A. M., Bertolini, A., Restelli, E., & Venco, A. (1996). Endogenous beta-endorphins in hypertension: correlation with 24-hour ambulatory blood pressure [published erratum appears in j Am Coll Cardiol 1997 Feb;29(2):474]. Journal of the American College of Cardiology, 28, 1243–1248.

    Article  PubMed  Google Scholar 

  • Guasti, L., Cattaneo, R., Rinaldi, O., Rossi, M. G., Bianchi, L., Gaudio, G., Grandi, A. M., Gorini, G., & Venco, A. (1995). Twenty-four-hour noninvasive blood pressure monitoring and pain perception. Hypertension, 25, 1301–1305.

    Article  PubMed  Google Scholar 

  • Guasti, L., Grimoldi, P., Diolisi, A., Petrozzino, M. R., Gaudio, G., Grandi, A. M., Rossi, M. G., & Venco, A. (1998). Treatment with enalapril modifies the pain perception pattern in hypertensive patients. Hypertension, 31, 1146–1150.

    Article  PubMed  Google Scholar 

  • Guasti, L., Zanotta, D., Diolisi, A., Garganico, D., Simoni, C., Gaudio, G., Grandi, A. M., & Venco, A. (2002). Changes in pain perception during treatment with angiotensin converting enzyme-inhibitors and angiotensin II type 1 receptor blockade, Journal of Hypertension, 20, 485–491.

    Article  PubMed  Google Scholar 

  • Heller, G. V., Garber, C. E., Connolly, M. J., Allen Rowlands, C. F., Siconolfi, S. F., Gann, D. S., & Carleton, R. A. (1987). Plasma beta-endorphin levels in silent myocardial ischemia induced by exercise. The American Journal of Cardiology, 59, 135–739.

    Article  Google Scholar 

  • Kardos, A., Rau, H., Greenlee, M. W., Droste, C., Brody, S., & Roskamm, H. (1994). Reduced pain during baroreceptor stimulation in patients with symptomatic and silent myocardial ischaemia. Cardiovascular Research, 28, 515–518.

    Article  PubMed  Google Scholar 

  • Kaski, J. C. (2002). Overview of gender aspects of cardiac syndrome X. Cardiovascular Research, 53, 620–626.

    Article  PubMed  Google Scholar 

  • Kaski, J. C., Crea, F., Nihoyannopoulos, P., Hackett, D., & Maseri, A. (1986). Transient myocardial ischemia during daily life in patients with syndrome X. The American Journal of Cardiology, 58, 1242–1247.

    Article  PubMed  Google Scholar 

  • Keogh, E., & Witt, G. (2001). Hypoalgesic effect of caffeine in normotensive men and women. Psychophysiology, 38, 886–895.

    Article  PubMed  Google Scholar 

  • Krittayaphong, R., & Sheps, D. S. (1996). Relation between blood pressure at rest and perception of angina pectoris during exercise testing. The American Journal of Cardiology, 77, 1224–1226.

    Article  PubMed  Google Scholar 

  • Kurita, A., Takase, B., Uehata, A., Sugahara, H., Nishioka, T., Maruyama, T., Satomura, K., Mizuno, K., & Nakamura, H. (1992). Differences in plasma beta-endorphin and bradykinin levels between patients with painless or with painful myocardial ischemia. American Heart Journal, 123, 304–309.

    Article  PubMed  Google Scholar 

  • Langer, A., & O’Connor, P. (1994). Central modulation of pain perception in patients with silent myocardial ischemia. The American fournal of Cardiology, 74, 182–184.

    Article  Google Scholar 

  • Laukkanen, J. A., Kurl, S., Lakka, T. A., Tuomainen, T. P., Rauramaa, R., Salonen, R., Eranen, J., & Salonen, J. T. (2001). Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men. Journal of the American College of Cardiology, 38, 72–79.

    Article  PubMed  Google Scholar 

  • LeBars, D., Villanueva, L., Bouhassira, D.,& Willer, J. C. (1992). Diffuse noxious inhibitory controls (DNIC) in animals and in man. Patologicheskaia fiziologiia i eksperimental’naia terapua, 4, 55–65.

    Google Scholar 

  • Lewis, J. W., Terman, G. W., Shavit, Y., Nelson, L. R., & Liebeskind, J. C. (1984). Neural, neurochemical, and hormonal bases of stress-induced analgesia. In L. Kruger & J. C. Liebeskind (Eds.), Advances in Pain Research and Therapy: Neural Mechanisms of Pain (6 ed., pp. 277–288). New York: Raven Press.

    Google Scholar 

  • Light, K. C., Herbst, M. C., Bragdon, E. E., Hinderliter, A. L., Koch, G. G., Davis, M. R., & Sheps, D S. (1991). Depression and type A behavior pattern in patients with coronary artery disease: relationships to painful versus silent myocardial ischemia and beta-endorphin responses during exercise. Psychosomatic Medicine, 53, 669–683.

    PubMed  Google Scholar 

  • Maixner, W Autonomic and somatosensory interactions: physiological and pathophysiological implications. Proceedings of the Finnish Dental Society, 85, 395–407.

    Google Scholar 

  • Maixner, W., Graceiy, R. H., Zuniga, J. R., Humphrey, C. B., & Bloodworth, G. R. (1990). Cardiovascular and sensory responses to forearm ischemia and dynamic hand exercise. American Journal of Physiology, 259, 1156–1163.

    Google Scholar 

  • Maixner, W., & Humphrey, C. (1993). Gender differences in pain and cardiovascular responses to forearm ischemia. Clinical Journal of Pain, 8, 16–25.

    Article  Google Scholar 

  • Maixner, W., Touw, K. B., Brody, M. J., Gebhart, G. F., & Long, J. P. (1982). Factors influencing the altered pain perception in the spontaneously hypertensive rat. Brain Research, 237, 137–145.

    Article  PubMed  Google Scholar 

  • Marchant, B., Umachandran, V., Wilkinson, P., Medbak, S., Kopelman, P. G., & Timmis, A. D. (1994). Reexammation of the role of endogenous opiates in silent myocardial ischemia. Journal of the American College of Cardiology, 23, 645–651.

    Article  PubMed  Google Scholar 

  • McCubbin, J. A., & Bruehl, S. (1994). Do endogenous opioids mediate the relationship between blood pressure and pain sensitivity in normotensives? Pain, 57, 63–67.

    Article  PubMed  Google Scholar 

  • Menotti, A., Mulder, L., Kromhout, D., Nissinen, A., Feskens, E. J., & Giampaoli, S. (2001). The association of silent electrocardiographic findings with coronary deaths among elderly men in three European countries. The FINE study. Acta Cardiologtca, 56, 27–36.

    Article  Google Scholar 

  • Miller, P. F., light, K. C., Bragdon, E. E., Ballenger, M. N., Herbst, M. C., Maixner, W., Hinderliter, A. L., Atkinson, S. S., Koch, G. G., & Sheps, D. S. (1993). Beta-endorphin response to exercise and mental stress in patients with ischemic heart disease. Journal of Psychosomatical Research, 37, 455–465.

    Article  Google Scholar 

  • Moltner, A., Holzl, R., & Strian, F. (1990). Heart rate changes as an autonomic component of the pain response. Pain, 43, 81–89.

    Article  PubMed  Google Scholar 

  • Myers, C. D., Robinson, M. E., Riley, J. L., III, & Sheffield, D. (2001). Sex, gender, and blood pressure: contributions to experimental pain report. Psychosomatical Medicine, 63, 545–550.

    Google Scholar 

  • Nyklicek, I., Vingerhoets, A. J., & Van Heck, G. L. (1999). Hypertension and pain sensitivity: effects of gender and cardiovascular reactivity. Biological Psychology, 50, 127–142.

    Article  PubMed  Google Scholar 

  • Page, G. D., & France, C. R. (1997). Objective evidence of decreased pain perception in normotensives at risk for hypertension. Pain, 73, 173–180.

    Article  PubMed  Google Scholar 

  • Pasceri, V., Lanza, G. A., Buffon, A., Montenero, A. S., Crea, F., & Maseri, A. (1998). Role of abnormal pain sensitivity and behavioral factors in determining chest pain in syndrome X. Journal of the American College of Cardiology, 31, 62–66.

    Article  PubMed  Google Scholar 

  • Pedersen, F., Pietersen, A., Madsen, J. K., Ballegaard, S., Meyer, C., & Trojaborg, W. (1989). Elevated pain threshold in patients with effort-induced angina pectoris and asymptomatic myocardial ischemia during exercise test. Clinical Cardiology, 12, 639–642.

    Article  PubMed  Google Scholar 

  • Rau, H., Brody, S., Larbig, W., Pauli, P., Vohringer, M., Harsch, B., Kroling, P., & Birbaumer, N. (1994). Effects of PRES baroreceptor stimulation on thermal and mechanical pain threshold in borderline hypertensives and normotensives. Psychopbysiology, 31, 480–485.

    Article  Google Scholar 

  • Rau, H., Schweizer, R., Zhuang, P., Pauli, P., Brody, S., Larbig, W., Heinle, H., Muller, M., Elbert, T., Dworkin, B., & (1993). Cigarette smoking, blood lipids, and baroreceptor-modulated nociception. Psychopharmacology, 110, 337–341.

    Article  PubMed  Google Scholar 

  • Sasaki, M., Ishizaki, K., Obata, H., & Goto, F. (2001). Effects of 5-HT2 and 5-HT3 receptors on the modulation of nociceptive transmission in rat spinal cord according to the formalin test. European Journal of Pharmacology, 424, 45–52.

    Article  PubMed  Google Scholar 

  • Sheffield, D., Biles, P. L., Orom, H., Maixner, W., & Sheps, D. S. (2000). Race and sex differences in cutaneous pain perception. Psychosomatic Medicine, 62, 517–523.

    PubMed  Google Scholar 

  • Sheps, D. S., Adams, K. F., Hinderliter, A., Price, C., Bissette, J., Orlando, G., Margolis, B., & Koch, G. (1987). Endorphins are related to pain perception in coronary artery disease. The American Journal of Cardiology, 59, 523–527.

    Article  PubMed  Google Scholar 

  • Sheps, D. S., Ballenger, M. N., De Gent, G. E., Krittayaphong, R., Dittman, E., Maixner, W., McCartney, W., Golden, R. N., Koch, G., & Light, K. C. (1995). Psychophysical responses to a speech Stressor: correlation of plasma beta-endorphin levels at rest and after psychological stress with thermally measured pain threshold in patients with coronary artery disease [see comments]. Journal of the American College of Cardiology, 25, 1499–1503.

    Article  PubMed  Google Scholar 

  • Sheps, D. S., Bragdon, E. E., Gray,T. F., Ballenger, M., Usedom, J. E., & Maixner, W. (1992a). Relation between systemic hypertension and pain perception. American Journal of Cardiology, 70, 3–5.

    Article  Google Scholar 

  • Siegel, W. G., Mark, D. B., Hlatky, M. A., Harrell, F. E., Jr., Pryor, D. B., Barefoot, J. G., & Williams, R. B., Jr. (1989). Clinical correlates and prognostic significance of type A behavior and silent myocardial ischemia on the treadmill. American Journal of Cardiology, 64, 1280–1283.

    Article  PubMed  Google Scholar 

  • Sitsen, J. M., & de Jong, W. (1983). Hypoalgesia in genetically hypertensive rats (SHR)is absent in rats with experimental hypertension. Hypertension, 5, 185–190.

    Article  PubMed  Google Scholar 

  • Stewart, K. M., & France, C. R. (1996). Resting systolic blood pressure, parental history of hypertension, and sensitivity to noxious stimuli. Pain, 68, 369–374.

    Article  PubMed  Google Scholar 

  • Turiel, M., Galassi, A. R., Glazier, J. J., Kaski, J. C., & Maseri, A. (1987). Pain threshold and tolerance in women with syndrome X and women with stable angina pectoris. American Journal of Cardiology, 60, 503–507.

    Article  PubMed  Google Scholar 

  • Weidinger, F., Hammerle, A., Sochor, H., Smetana, R., Frass, M., & Glogar, D. (1986). Role of beta-endorphins in silent myocardial ischemia. American Journal of Cardiology, 58, 428–430.

    Article  PubMed  Google Scholar 

  • Zamir, N., & Segal, M. (1979). Hypertension-induced analgesia: changes in pain sensitivity in experimental hypertensive rats. Brain Research, 160, 170–173.

    Article  PubMed  Google Scholar 

  • Zamir, N., Segal, M., & Simantov, R. (1980). Pain sensitivity and opioid activity in genetically and experimentally hypertensive rats. Brain Research, 184, 299–310.

    Article  PubMed  Google Scholar 

  • Zamir, N., & Shuber, H. (1980). Altered pain perception in hypertensive humans. Brain Research, 201, 471–474.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media New York

About this chapter

Cite this chapter

Fillingim, R.B. (2004). Alterations in Pain Perception in Cardiovascular Disease. In: Lautenbacher, S., Fillingim, R.B. (eds) Pathophysiology of Pain Perception. Plenum Series in Rehabilitation and Health. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-9068-6_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-9068-6_13

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-4780-4

  • Online ISBN: 978-1-4419-9068-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics