Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study

Background Unrecognized myocardial infarction (MI) is a prevalent condition associated with a similar risk of death as recognized MI. It is unknown why some persons experience MI with few or no symptoms; however, one possible explanation is attenuated pain sensitivity. To our knowledge, no previous...

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Main Authors: Andrea Milde Øhrn, Christopher Sivert Nielsen, Henrik Schirmer, Audun Stubhaug, Tom Wilsgaard, Haakon Lindekleiv
Format: Article
Language:English
Published: Wiley 2016-12-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
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Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.116.003846
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author Andrea Milde Øhrn
Christopher Sivert Nielsen
Henrik Schirmer
Audun Stubhaug
Tom Wilsgaard
Haakon Lindekleiv
author_facet Andrea Milde Øhrn
Christopher Sivert Nielsen
Henrik Schirmer
Audun Stubhaug
Tom Wilsgaard
Haakon Lindekleiv
author_sort Andrea Milde Øhrn
collection DOAJ
description Background Unrecognized myocardial infarction (MI) is a prevalent condition associated with a similar risk of death as recognized MI. It is unknown why some persons experience MI with few or no symptoms; however, one possible explanation is attenuated pain sensitivity. To our knowledge, no previous study has examined the association between pain sensitivity and recognition of MI. Methods and Results We conducted a population‐based cross‐sectional study with 4849 included participants who underwent the cold pressor test (a common experimental pain assay) and ECG. Unrecognized MI was present in 387 (8%) and recognized MI in 227 (4.7%) participants. Participants with unrecognized MI endured the cold pressor test significantly longer than participants with recognized MI (hazard ratio for aborting the cold pressor test, 0.64; CI, 0.47–0.88), adjusted for age and sex. The association was attenuated and borderline significant after multivariable adjustment. The association between unrecognized MI and lower pain sensitivity was stronger in women than in men, and statistically significant in women only, but interaction testing was not statistically significant (P for interaction=0.14). Conclusions Our findings suggest that persons who experience unrecognized MI have reduced pain sensitivity compared with persons who experience recognized MI. This may partially explain the lack of symptoms associated with unrecognized MI.
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spelling doaj-art-db0f09d6683948ec9896132b60d284172025-08-20T03:29:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-12-0151210.1161/JAHA.116.003846Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional StudyAndrea Milde Øhrn0Christopher Sivert Nielsen1Henrik Schirmer2Audun Stubhaug3Tom Wilsgaard4Haakon Lindekleiv5Faculty of Health Sciences University of Tromsø NorwayDivision of Mental Health Norwegian Institute of Public Health Oslo NorwayFaculty of Health Sciences University of Tromsø NorwayDepartment of Pain Management and Research Oslo University Hospital Oslo NorwayFaculty of Health Sciences University of Tromsø NorwayFaculty of Health Sciences University of Tromsø NorwayBackground Unrecognized myocardial infarction (MI) is a prevalent condition associated with a similar risk of death as recognized MI. It is unknown why some persons experience MI with few or no symptoms; however, one possible explanation is attenuated pain sensitivity. To our knowledge, no previous study has examined the association between pain sensitivity and recognition of MI. Methods and Results We conducted a population‐based cross‐sectional study with 4849 included participants who underwent the cold pressor test (a common experimental pain assay) and ECG. Unrecognized MI was present in 387 (8%) and recognized MI in 227 (4.7%) participants. Participants with unrecognized MI endured the cold pressor test significantly longer than participants with recognized MI (hazard ratio for aborting the cold pressor test, 0.64; CI, 0.47–0.88), adjusted for age and sex. The association was attenuated and borderline significant after multivariable adjustment. The association between unrecognized MI and lower pain sensitivity was stronger in women than in men, and statistically significant in women only, but interaction testing was not statistically significant (P for interaction=0.14). Conclusions Our findings suggest that persons who experience unrecognized MI have reduced pain sensitivity compared with persons who experience recognized MI. This may partially explain the lack of symptoms associated with unrecognized MI.https://www.ahajournals.org/doi/10.1161/JAHA.116.003846epidemiologymyocardial infarctionpain tolerancesilent myocardial infarctionunrecognized myocardial infarction
spellingShingle Andrea Milde Øhrn
Christopher Sivert Nielsen
Henrik Schirmer
Audun Stubhaug
Tom Wilsgaard
Haakon Lindekleiv
Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
epidemiology
myocardial infarction
pain tolerance
silent myocardial infarction
unrecognized myocardial infarction
title Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study
title_full Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study
title_fullStr Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study
title_full_unstemmed Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study
title_short Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study
title_sort pain tolerance in persons with recognized and unrecognized myocardial infarction a population based cross sectional study
topic epidemiology
myocardial infarction
pain tolerance
silent myocardial infarction
unrecognized myocardial infarction
url https://www.ahajournals.org/doi/10.1161/JAHA.116.003846
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