Open AccessThe Clinical Significance of Somatic Pain Tolerance in Patients with Coronary Artery Disease
Author(s) -
Narins Craig R.,
Zareba Wojciech,
Moss Arthur J.,
Brown Mary W.,
Case Robert B.,
Case Nan,
Goldstein Robert E.
Publication year - 1997
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/j.1542-474x.1997.tb00198.x
Subject(s) - medicine , myocardial infarction , cardiology , pain tolerance , coronary artery disease , angina , unstable angina , chest pain , revascularization , electrocardiography , threshold of pain
Methods Two hundred seventy‐one patients with a recent acute coronary event underwent pain tolerance testing using the tourniquet test. Baseline ambulatory and exercise electrocardiography, and stress thallium scintigraphy were performed, and patients were followed prospectively for a mean of 33 ± 8 months for the occurrence of unstable angina, nonfatal myocardial infarction (Ml), or cardiac death. Results Patients with lower tolerance to somatic pain were significantly older (P = 0.001), had more clinical angina (P = 0.04), and on multivariate analysis had poorer exercise tolerance (P = 0.002) than those with higher pain tolerance. Low and high pain tolerance patients demonstrated similar degrees of myocardial ischemia on noninvasive testing and had similar cardiac event rates (death, nonfatal Ml, or unstable angina) during the follow‐up period. Conclusions Despite demonstrating a similar frequency of myocardial ischemia and similar prognosis as patients with high pain tolerance, individuals with low pain tolerance were more likely to experience clinical symptoms and functional impairment, providing evidence that individual differences in somatic pain tolerance influence the symptomatic expression of coronary disease.