PubMed Health⌕ Search

Biomedical subjects

D Sheffield

Publications and source records attributed to D Sheffield.

At least 19 recordsLinked to original sources
PubMed2001

Effects of stress and relaxation on capsaicin-induced pain.

A sizable body of research has been devoted to understanding the relationship between pain sensitivity and the psychological state of the individual. Considerable disagreement as to the direction of the association still exists. This study examines the effects of 2 experimental manipulations, cognitive/emotional stress and relaxation, on capsaicin-induced pain. Subjects were pretrained in relaxation and then randomized to experimental stress produced by a 20-minute Stroop test, relaxation (tape), or a control condition (neutral video), followed by a capsaicin injection in the forearm. Cardiovascular measures were taken at regular intervals, and cortisol, norepinephrine (NE), and self-reports of arousal (relaxation index) were taken immediately before and after the experimental task. The manipulation significantly interacted with sex to predict capsaicin-induced maximum pain. Women in the stress condition reported greater pain than both men in the stress condition and women in the relaxation condition. Pain was correlated negatively with task-induced changes in NE and cortisol and positively with self-reported arousal (decreased relaxation). However, separate analyses showed that some physiologic indexes of heightened arousal (increased blood pressure and NE) predicted lower pain only in men, whereas subjective increases in arousal predicted higher pain only in women. Multiple hierarchical regression analyses confirmed that physiologic and self-reported arousal predicted pain independently and in opposite directions, and a model including both accounted for 56% of the overall variance. These findings suggest that a unidimensional model of arousal may be insufficient to explain the effects of stress on pain and that these effects operate differently in men and women.

Clinical Trial↗
PubMed2001

Sex differences in chest pain in patients with documented coronary artery disease and exercise-induced ischemia: Results from the PIMI study.

BACKGROUND: Sex differences in the pathophysiologic course of coronary artery disease (CAD) are widely recognized, yet accurate diagnosis of coronary artery disease in women remains challenging. METHODS: To determine sex differences in the clinical manifestation of CAD, we studied chest pain reported during daily activities, exercise, and mental stress in 170 men and 26 women. All patients had documented CAD (>50% narrowing in at least 1 major coronary artery or prior myocardial infarction) and all had 1-mm ST-segment depression on treadmill exercise. We collected psychologic test results, serum samples (potassium, epinephrine, norepinephrine, cortisol, b-endorphin, and glucose), and cardiac function, sensory threshold, and autonomic function data at specified times before, during, or after exercise and mental stress tests to assess measures of depression, anxiety, and neurohormonal and thermal pain perception. RESULTS: Women reported chest pain more often than men during daily activities (P =.04) and during laboratory mental stressors (P =.01) but not during exercise. Men had lower scores than women on measures of depression, trait anxiety, harm avoidance, and reward dependence (P <.05 for all). Women had significantly lower plasma b-endorphin levels at rest (4.2 +/- 3.9 vs 5.0 +/- 2.5 pmol/L for men, P =.005) and at maximal mental stress (6.4 +/- 5.1 vs 7.4 +/- 3.5 pmol/L for men, P <.01). A higher proportion of women than men had marked pain sensitivity to graded heat stimuli applied to skin (hot pain threshold <41 degrees C, 33% vs 10%, P =.001). CONCLUSIONS: Our results reflect sex differences in the affective and discriminative aspects of pain perception and may help explain sex-related differences in clinical presentations.

Activities of Daily Living↗
PubMed2001

Depression, anxiety, and the cardiovascular system: the cardiologist's perspective.

Up to one fifth of patients with cardiovascular disease, including those who have experienced a myocardial infarction, may have concomitant major depression. Studies have suggested that the relative risk of major depression with cardiovascular disease ranges from 1.5 to 4.5. Further information is required to establish a dose-response relationship between depression and coronary artery disease (CAD); however, such a relationship has been shown between anxiety and CAD. Development of a conceptual model of the pathophysiologic actions of stress in CAD will assist in the understanding of this relationship. In patients with angiographic evidence of CAD, the presence of major depressive disorder was the best single predictor of cardiac events during the 12 months following diagnosis. Significantly, 6-month cumulative mortality following diagnosis of myocardial infarction has been shown to be higher in depressed patients than in nondepressed patients. A decrease in heart rate variability may mediate the deleterious effect of depression on post-myocardial infarction prognosis. Other factors such as mental stress and altered platelet function may also predispose depressed patients to a heightened risk of cardiac events. With an increased understanding of the relationship between depression and heightened risk of cardiovascular mortality, it is necessary to assess current overall treatment for cardiac patients.

Anxiety Disorders↗
PubMed1999

Comparison of perception of angina pectoris during exercise testing in African-Americans versus Caucasians.

In a sample of 142 patients with positive treadmill test results, we found that African-Americans reported anginal pain during exercise at nearly twice the rate of Caucasians, and had a significantly shorter time to angina. The mechanisms for these race differences remain to be elucidated, but may include underlying physiologic responses, ethnocultural differences, psychological state, socioeconomic differences, and experimenter bias.

Black or African American↗
PubMed1999

Low hot pain threshold predicts shorter time to exercise-induced angina: results from the psychophysiological investigations of myocardial ischemia (PIMI) study.

OBJECTIVES: The purpose of this study was to test whether cutaneous thermal pain thresholds are related to anginal pain perception. BACKGROUND: Few ischemic episodes are associated with angina; symptoms have been related to pain perception thresholds. METHODS: A total of 196 patients with documented coronary artery disease underwent bicycle exercise testing and thermal pain testing. The Marstock test of cutaneous sensory perception was administered at baseline after 30 min of rest on two days and after exercise and mental stress. Resting hot pain thresholds (HPTs) were averaged for the two baseline visits and divided into two groups: 1) average HPT <41 degrees C, and 2) average HPT > or =41 degrees C, to be clearly indicative of abnormal hypersensitivity to noxious heat. RESULTS: Patients with HPT <41 degrees C had significantly shorter time to angina onset on exercise testing than patients with HPT > or =41 degrees C (p < 0.04, log-rank test). Heart rates, systolic blood pressure and rate-pressure product at peak exercise were not different for the two groups. Resting plasma beta-endorphin levels were significantly higher in the HPT <41 degrees C group (5.9+/-3.7 pmol/liter vs. 4.7+/-2.8 pmol/liter, p = 0.02). Using a Cox proportional hazards model, patients with HPT <41 degrees C had an increased risk of angina (p = 0.03, rate ratio = 2.0). These differences persisted after adjustment for age, gender, depression, anxiety and history of diabetes or hypertension (p < 0.01). CONCLUSIONS: Occurrence of angina and timing of angina onset on an exercise test are related to overall hot pain sensory perception. The mechanism of this relationship requires further study.

Adult↗
PubMed1998

Social psychophysiology, social circumstances, and health.

Health varies markedly with social circumstances. While we are still without a comprehensive account of the mechanisms which underlie this variation, it is clear that psychological factors are involved and that key pathways may prove to be psychophysiological. Thus, social psychophysiological research of the kind illustrated in this Special Issue is ideally placed to help unravel some of the mechanisms by which social circumstances impact on health. Nevertheless, the success of this sort of social psychophysiological enterprise most likely depends on reconceptualizing psychophysiological reactivity as a situational, or psychological exposure, concept rather than as an individual difference concept. This shifts the research goal from one of identifying individuals at risk for disease to identifying the psychological exposures that put individuals and groups at risk.

Adaptation, Psychological↗
PubMed1998

Heart rate variability at rest and during mental stress in patients with coronary artery disease: differences in patients with high and low depression scores.

This study tested the hypothesis that coronary artery disease (CAD) patients with high depressed mood scores differ in sympatho-vagal balance during mental stress compared to patients with low depressed mood scores. Using electrocardiographic monitoring, heart variability data from spectral analysis and hemodynamic parameters were obtained prior to and during mental stress from 34 men and 7 women. A public speaking task was used as the mental stressor. Patients were grouped by a median split of their Minnesota Multiphasic Personality Inventory-Depression score. During mental stress, patients with higher depression scores had greater changes in peak heart rate (p < .05) and low frequency to high frequency power ratio (p < 0.05) than patients with lower scores suggesting a shift toward more sympathetic activity during mental stress. These findings may be related to the reported relation between depression and survival risk in patients with CAD.

Journal Article↗
PubMed1997

Association of systolic blood pressure at time of myocardial ischemia with angina pectoris during exercise testing.

In a sample of 306 patients with positive treadmill test results, we found that patients with silent ischemia had a higher systolic blood pressure at onset of ST depression than patients with painful ischemia. We conclude that systolic blood pressure at the time of ischemia influences the experience of angina during exercise in a manner consistent with acute activation of baroreceptors and resulting antinociception.

Angina Pectoris↗
PubMed1997

The effects of blood pressure resting level and lability on cardiovascular reactions to laboratory stress.

Evidence that individuals with elevated resting blood pressures display excessive cardiovascular reactions to laboratory stress is regarded as implicating excessive reactivity in the pathogenesis of hypertension. However, it remains possible that this relationship is artifactual, in that resting blood pressure levels and cardiovascular reactions might both reflect intrinsic cardiovascular lability. To examine this possibility, blood pressure and heart rate were measured at rest and in response to an active laboratory stressor in 1259 men. Systolic blood pressure and heart rate reactions to the stressor were predicted by resting blood pressure. Although cardiovascular lability showed some association with both reactivity and resting blood pressure level, the resting blood pressure level-reactivity relationship survived statistical adjustment for such associations. Accordingly, the excessive cardiovascular reactions characteristic of individuals with elevated resting blood pressure would not appear to be explainable, to any substantial extent, by lability effects.

Adult↗
PubMed1997

The relationship between resting systolic blood pressure and cutaneous pain perception in cardiac patients with angina pectoris and controls.

In order to determine the influence of resting systolic blood pressure and stable angina on cutaneous pain perception, we studied 19 male cardiac patients with stable angina and 16 male controls. Pain perception was measured using a suprathreshold evaluation of pain intensity and pain unpleasantness to a series of thermal stimuli. We found that men with higher resting blood pressure had a decrease in the perception of pain intensity and pain unpleasantness. Similarly, we found that patients with stable angina perceived pain as less intense and unpleasant than controls. These differences in pain perception may be associated with different pain mechanisms: in the case of blood pressure, differences in opioid activity and baroreceptor-regulated pain systems; in the case of stable angina, patients may adapt to continued experiences of pain, altering internal frames of reference.

Analysis of Variance↗
PubMed1997

The relationship between socioeconomic status, hostility, and blood pressure reactions to mental stress in men: data from the Whitehall II study.

This study investigated the relationship among blood pressure reactions to mental stress, cynical hostility, and socioeconomic status (SES) in 1,091 male public servants. Occupational grade served to index SES and cynical hostility was assessed using the Cook-Medley scale. (Cook & Medley, 1954). The magnitude of systolic, but not diastolic, blood pressure change scores to stress was positively associated with occupational grade: the higher the grade, the greater the reactions. Mental stress task performance also varied with occupational grade but was unrelated to reactivity. Ratings of task difficulty did not vary with occupational grade. Cynical hostility was negatively related to occupational grade, and, contrary to previous findings, negatively related to systolic blood pressure reactivity. Cynical hostility was also negatively related to mental stress task performance but unrelated to ratings of task difficulty.

Adult↗
PubMed1997

The effects of recent food, alcohol, and tobacco intake and the temporal scheduling of testing on cardiovascular activity at rest and during psychological stress.

Participants in cardiovascular psychophysiological studies receive various instructions regarding restraints on alcohol, food, and tobacco intake prior to testing. Further, although the hour of testing is frequently a concern, little attention is paid to month of the year. In the present study, we examined cardiovascular activity at rest and in response to a laboratory stress task in 1,272 men in terms of these variables. Alcohol consumption among alcohol users and food intake within 4 hr of testing were associated with higher baseline diastolic blood pressure (BP) but lower baseline heart rate (HR). Tobacco use in smokers within 1 hr of testing was associated with elevated baseline BP and HR. Hour of testing was related to baseline HR, whereas month of the year was associated with baseline BP. In contrast to these baseline effects, cardiovascular reactions to the laboratory stress task were largely immune to these contextual influences.

Adult↗
PubMed1996

Daily events and somatic symptoms: evidence of a lagged relationship.

In order to examine the lagged relationship between daily events and somatic symptoms, 48 students completed the Students Assessment of Daily Experience Questionnaire and the Somatic Symptoms subscale of the General Health Questionnaire for five days. Undesirable events were correlated with somatic symptoms three to four days later.

Adolescent↗
PubMed1996

Blood pressure reactions to the cold pressor test and the prediction of future blood pressure status: data from the Caerphilly study.

The prognostic significance of the cold pressor test in hypertension remains a matter of controversy. Following determination at an initial screening session, blood pressure (BP) was recorded at baseline rest and in reaction to a cold pressor test. Follow-up screening BP was determined 5 years later. The effective sample was 1039 men, with an average age of 56.6 years at initial screening. Step-wise multiple regression indicated that BP reactions to the cold pressor test provided minimal independent prediction of follow-up BP over and above that afforded by BP at initial screening. In the case of follow-up systolic pressure, a model including only age and initial screening systolic BP (SBP) accounted for 38% of the variance; SBP reactions to the cold pressor did not enter the regression equation. In the case of follow-up diastolic BP (DBP), diastolic pressure at initial screening accounted for 21% of the variance, and while DBP reaction to the cold pressor test entered the equation, it accounted for only an additional 1% of the variance. These results suggest that the cold pressor test may be of limited clinical use in older populations.

Blood Pressure↗
PubMed1995

Pressor reactions to psychological stress and prediction of future blood pressure: data from the Whitehall II Study.

OBJECTIVE: To examine whether reactions of blood pressure to psychological stress predict future blood pressure. DESIGN: Blood pressure was recorded at a medical screening examination after which pressor reactions to a psychological stress task were determined. Follow up measurement of blood pressure was undertaken, on average, 4.9 years later. SETTING: 20 civil service departments in London. SUBJECTS: 1003 male civil servants aged between 35 and 55 years at entry to the study. MAIN OUTCOME MEASURE: Blood pressure at follow up screening. RESULTS: Reactions of systolic blood pressure to stress correlated positively with systolic blood pressure at follow up screening (r = 0.22, P < 0.01). The dominant correlate of follow up blood pressure was blood pressure at initial screening (r = 0.60; P < 0.01 between initial and follow up systolic blood pressure; r = 0.59, P < 0.01 between initial and follow up diastolic blood pressure). Stepwise multiple regression analysis indicated that reactions to the stressor provided minimal prediction of follow up blood pressure over and above that afforded by blood pressure at initial screening. In the case of follow up systolic blood pressure, systolic reactions to stress accounted for only 1% of follow up variance; systolic blood pressure at initial screening accounted for 34%. With regard to diastolic blood pressure at follow up, the independent contribution from diastolic reactions to stress was less than 1%. CONCLUSION: Pressor reactions to psychological stress provide minimal independent prediction of blood pressure at follow up. Measurement of reactivity is not a useful clinical index of the course of future blood pressure.

Adult↗