Abstract
Baroreceptors are mechanosensitive elements of the peripheral nervous system that maintain homeostasis by coordinating physiologic responses to external and internal stimuli. While it is recognized that carotid and cardiopulmonary baroreceptor reflexes modulate autonomic output to mitigate excessive fluctuations in arterial blood pressure and to maintain intravascular volume, increasing evidence suggests that baroreflex pathways also project to key regions of the central nervous system that regulate somatosensory, somatomotor, and central nervous system arousal. In addition to maintaining autonomic homeostasis, baroreceptor activity modulates the perception of pain, as well as neuroimmune, neuroendocrine, and cognitive responses to physical and psychologic stressors. This review summarizes the role that baroreceptor pathways play in modulating acute and chronic pain perception. The contribution of baroreceptor function to postoperative outcomes is also presented. Finally, methods that enhance baroreceptor function, which hold promise in improving postoperative and pain management outcomes, are presented.
Highlights
The central (CNS) and peripheral (PNS) nervous systems work in concert to maintain homeostasis in response to psychological and physical stressors
We summarize the neurobiology of the baroreceptor function and how baroreflex mechanisms are thought to contribute to acute and chronic pain conditions as well as perioperative outcomes
We have summarized the evidence suggesting a role for baroreceptor function in both acute and chronic pain conditions as well as perioperative outcomes
Summary
The central (CNS) and peripheral (PNS) nervous systems work in concert to maintain homeostasis in response to psychological and physical stressors. Low BRS is commonly seen in patients with hypertension and diabetes[149,150], carotid atherosclerosis[151,152], obesity[153], in smokers[154], and high alcohol consumption.[155] Patients with obstructive sleep apnea have an attenuated BRS156, which is associated with increased blood pressure variability[157], increased sympathetic activity[158], desensitization of vascular adrenergic receptors, and decreased peripheral vascular adrenergic responses.[159] In the context of perioperative outcomes, this autonomic dysfunction is of relevance since it is linked to cardiovascular morbidity and obstructive sleep apnea.[160] Autonomic dysfunction is prevalent in patients with chronic kidney disease who have an increased risk of sudden cardiac death associated with reduced spontaneous BRS.[161] Interestingly, BRS dysfunction is correlated with glomerular filtration rate[162], suggesting that there is a direct association between reduced BRS and declining renal function All of these BRS-associated events can be further aggravated by the fact that prolonged bed rest induces rapid detrimental changes in baroreflex function.[163] Congruent with a baroreflex-mediated modulation of pain, there is an increased prevalence of chronic pain and/or greater pain perception in patients with conditions with reduced BRS as well as obstructive sleep apnea[164], diabetes[165], obesity[166], chronic kidney disease 167, smoking[168], alcoholism[169], and hypertension[170], the mechanisms mediating these associations are not yet well understood. Future studies are required to assess the effects of these procedures on BRS, acute and chronic pain perception and perioperative surgical outcomes
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