European Heart Journal Advance Access originally published online on March 24, 2005
European Heart Journal 2005 26(10):975-982; doi:10.1093/eurheartj/ehi229
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Abnormal cortical pain processing in patients with cardiac syndrome X
1Divisione di Neurologia, Ospedale Pediatrico ‘Bambino Gesù’—IRCCS, Roma, Italy
2Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma, Italy
3Divisione di Riabilitazione Neuromotoria, Casa di Cura San Raffaele Pisana, IRCCS, via della Pisana 235, 00165 Roma, Italy
4Istituto di Neurologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma, Italy
Received 25 October 2004; revised 11 February 2005; accepted 17 February 2005; online publish-ahead-of-print 24 March 2005.
* Corresponding author. Tel: +39 06 3015 4187; fax +39 06 3055 535. E-mail address: g.a.lanza{at}inwind.it
See page 946 for the editorial comment on this article (doi:10.1093/eurheartj/ehi242)
Aims Previous studies suggested that an enhanced pain sensitivity is present in patients with cardiac syndrome X (SX). We investigated whether SX patients present abnormalities in the electrical cerebral signals generated by pain stimuli.
Methods and results Cortical laser evoked potentials (LEPs) were recorded in 16 SX patients, in 10 patients with refractory angina due to obstructive coronary artery disease (CAD) and in 13 healthy controls. LEPs were recorded during stimulation of chest and right hand dorsum. Three sequences of painful stimuli were applied at each site. Subjective pain rating was assessed by a 0–100 mm visual analogic scale (VAS). Basal LEPs did not differ among groups and there were no differences for most LEP components across the repetitions of stimuli. However, the amplitude of the N2/P2 LEP component, specifically reflecting cortical pain processing, decreased across the three sequences of stimuli in controls and CAD patients, but not in SX patients. Compared with the first sequence, the N2/P2 amplitude during the third sequence of stimuli in the three groups was 77±16, 56±24, and 99±34%, respectively, for chest (P=0.001), and 63±31, 72±17, and 98±46%, respectively, for right hand (P=0.03) stimulation. The changes in VAS pain score across the three sequences paralleled those of N2/P2 amplitude.
Conclusion Our data show that in SX patients, central handling of painful stimuli is characterized by inadequate habituation, which might play a role in determining the peculiar clinical characteristics of anginal chest pain of these patients.
Key Words: Syndrome X • Pain • Cortical laser evoked potentials
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