A Fast Track to Hypoalgesia – The Anaerobic Exercise Effect on Pain Sensitivity

Abstract

Maximal anaerobic exercise, is a short high intensity effort, involves activation of the hypothalamus-pituitary-adrenal axis, and may suggest hypoalgesic effects. In addition, this exercise-induced muscle pain may contribute to hypoalgesia via the pain inhibits pain phenomenon, which is related to the diffuse noxious inhibitory control (DNIC) mechanism. We aimed to investigate whether: 1) a single bout of 30 s maximal anaerobic exercise has an analgesic effect on experimental pain sensitivity; 2) DNIC is the underlying mechanism of anaerobic exercise-induced hypoalgesia (EIH). Fifty healthy subjects participated. The experimental group performed the ‘Wingate Anaerobic Test’ (WAT) and controls set on the bikes without exercising. Psychophysical tests, performed before and after the intervention, in local and remote areas, included: heat (HPT) and pressure pain thresholds (PPT); suprathreshold heat and cold pain stimulation; the conditioned pain modulation (CPM) paradigm testing the DNIC mechanism. Following WAT, PPT and HPT increased (p<0.001) , pain ratings in response to heat and cold stimuli (p<0.001) and CPM (p=0.029) decreased compared with controls. No correlation was found between muscle pain, blood lactate level and EIH. To conclude WAT induces local and remote analgesic effects. The involvement of central pain modulatory processes with DNIC probably not the underline mechanism of EIH.

Key words

quantitative sensory testing - anaerobic exercise - stress - anxiety - maximal anaerobic performance

• References

• 1 Bars DL, Chitour D, Kraus E, Clot AM, Dickenson AH, Besson JM. The effect of systemic morphine upon diffuse noxious inhibitory controls (DNIC) in the rat: Evidence for a lifting of certain descending inhibitory controls of dorsal horn convergent neurones. Brain Res. 1981; 215: 257-274
• 2 Bartholomew JB, Lewis BP, Linder DE, Cook DB. Post exercise analgesia: Replication and extension. J Sports Sci. 1996; 14: 329-334
• 3 Bodnar RJ, Kelly DD, Spiaggia A, Ehrenberg C, Glusman M. Dose-dependent reductions by naloxone of analgesia induced by cold-water stress. Pharmacol Biochem Behav 1978; 8: 667-672
• 4 Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund ULF, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 195: 1381-1395
• 5 Borg G, Ljunggren G, Ceci R. The increase of perceived exertion, aches and pain in the legs, heart rate and blood lactate during exercise on a bicycle ergometer. Eur J Appl Physiol 1985; 54: 343-349
• 6 Bouhassira D, Villanueva L, Le Bars D. Effects of systematic morphine on diffuse noxious inhibitory controls: Role of the periaqueductal grey. Eur J Pharmacol. 1992; 216: 149-156
• 7 Bouhassira D, Villanueva L, Le Bars D. Intracerebroventricular morphine decreases descending inhibitions acting on lumbar dorsal horn neuronal activities related to pain in the rat. J Pharm Exp Ther 1988; 247: 332-342
• 8 Brooks S, Burrin J, Cheetham ME, Hall GM, Yeo T, Williams C. The responses of the catecholamines and β-endorphin to brief maximal exercise in man. Eur J Appl Physiol 1988; 57: 230-234
• 9 Chitour D, Dickenson AH. Le Bars D. Pharmacological evidence for the involvement of serotonergic mechanisms in diffuse noxious inhibitory controls (DNIC). Brain Res 1982; 236: 329-337
• 10 Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24: 385-396
• 11 Cook DB, O'Connor PJ, Eubanks SA, Smith JC, Lee M. Naturally occurring muscle pain during exercise: Assessment and experimental evidence. Med Sci Sports Exerc 1997; 29: 999-1012
• 12 de Meirleir K, Naaktgeboren N, Van Steirteghem A, Gorus F, Olbrecht J, Block P. Beta-endorphin and ACTH levels in peripheral blood during and after aerobic and anaerobic exercise. Eur J Appl Physiol 1986; 55: 5-8
• 13 Droste C, Greenlee MW, Schreck M, Roskamm H. Experimental pain thresholds and plasma beta-endorphin levels during exercise. Med Sci Sports Exerc 1991; 23: 334
• 14 Ellingson LD, Koltyn KF, Kim JS, Cook DB. Does exercise induce hypoalgesia through conditioned pain modulation?. Psychophysiology 2014; 51: 267-276
• 15 Gardell LR, Wang R, Burgess SE, Ossipov MH, Vanderah TW, Malan TP, Lai J, Porreca F. Sustained morphine exposure induces a spinal dynorphin-dependent enhancement of excitatory transmitter release from primary afferent fibers. J Neurosci 2002; 22: 6747-6755
• 16 Goldfarb A, Hatfield BD, Armstrong D, Potts J. Plasma beta-endorphin concentration: response to intensity and duration of exercise. Med Sci Sports Exerc 1990; 22: 241-244
• 17 Gregory NS, Whitley PE, Sluka KA. Effect of intramuscular protons, lactate, and ATP on muscle hyperalgesia in rats. PloS One 2015; 10: e0138576
• 18 Gurevich M, Kohn PM, Davis C. Exercise induced analgesia and the role of reactivity in pain sensitivity. J Sports Sci 1994; 12: 549-559
• 19 Haier RJ, Quaid K, Mills JC. Naloxone alters pain perception after jogging. Psychiat Res 1981; 5: 231-232
• 20 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 Update. Int J Sports Med 2017; 38: 1126-1131
• 21 Hoffman MD, Shepanski MA, Ruble SB, Valic Z, Buckwalter JB, Clifford PS. Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain. Arch Phys Med Rehabil 2004; 85: 1183-1187
• 22 Jacks DE, Sowash J, Anning J, Mcgloughlin T, Andres F. Effect of exercise at three exercise intensities on salivary cortisol. J Strength Cond Res 2002; 16: 286-289
• 23 Janal MN, Colt EW, Clark WC, Glusman M. Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: effects of naloxone. Pain 1984; 19: 13-25
• 24 Kemppainen P, Hamalainen O, Kononen M. Different effects of physical exercise on cold pain sensitivity in fighter pilots with and without the history of acute in-flight neck pain attacks. Med sci Sports Exerc 1998; 30: 577-582
• 25 Kemppainen P, Pertovaara A, Huopaniemi T, Johansson G, Karonen SL. Modification of dental pain and cutaneous thermal sensitivity by physical exercise in man. Brain Res 1985; 360: 33-40
• 26 Kodesh E, Weissman-Fogel I. Exercise-induced hypoalgesia - interval versus continuous mode. Appl Physiol Nutr Metab 2014; 39: 829-834
• 27 Koltyn KF. Analgesia following exercise: A review. Sports Med 2000; 29: 85-98
• 28 Koltyn KF. Exercise-induced hypoalgesia and intensity of exercise. Sports Med 2002; 32: 477-487
• 29 Koltyn KF, Garvin AW, Gardiner RL, Nelson TF. Perception of pain following aerobic exercise. Med Sci Sports Exercise 1996; 28: 1418-1421
• 30 Koltyn KF, Umeda M. Exercise, hypoalgesia and blood pressure. Sports Med 2006; 36: 207-214
• 31 Le Bars D, Willer JC, De Broucker T. Morphine blocks descending pain inhibitory controls in humans. Pain 1992; 48: 13-20
• 32 Lemley KJ, Hunter SK, Hoeger BM. Conditioned pain modulation predicts exercise-induced hypoalgesia in healthy adults. Med Sci Sports Exerc 2015; 47: 176-184
• 33 Naugle KM, Fillingim RB, Riley III JL. A meta-analytic review of the hypoalgesic effects of exercise. J Pain 2012; 13: 1139-1150
• 34 Nirl RR, Granovskyl Y, Yarnitskyl D, Sprecherl E, Granotl M. A psychophysical study of endogenous analgesia: The role of the conditioning pain in the induction and magnitude of conditioned pain modulation. Eur J Pain 2011; 15: 491-497
• 35 Patton JF, Murphy MM, Frederick FA. Maximal power outputs during the Wingate anaerobic test. Int J Sports Med 1985; 6: 82-85
• 36 Pud D, Granovsky Y, Yarnitsky D. The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)-like effect in humans. Pain 2009; 144: 16-19
• 37 Ram KC, Eisenberg E, Haddad M, Pud D. Oral opioid use alters DNIC but not cold pain perception in patients with chronic pain–new perspective of opioid-induced hyperalgesia. Pain 2008; 139: 431-438
• 38 Scheef L, Jankowski J, Daamen MJ. Weyer J. Klingenberg M, Renner J, Mueckter S, Schürmann B, Musshoff F, Wagner M, Schild HH. Zimmer A, Boecker H. An fMRI study on the acute effects of exercise on pain processing in trained athletes. Pain 2012; 153: 1702-1714
• 39 Spielberger CD, Barratt ES. Anxiety: Current trends in theory and research. New York: Academic Press; 1972: 31-45
• 40 Stein C. Opioid receptors. Annu Rev Med 2016; 67: 433-451
• 41 Stolzman S, Bement MH. Does exercise decrease pain via conditioned pain modulation in adolescents?. Pediatr Phys Ther 2016; 28: 470
• 42 Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: Development and validation. Psychol Assess 1995; 7: 524
• 43 Svedahl K, MacIntosh BR. Anaerobic threshold: the concept and methods of measurement. Can J Appl Physiol 2003; 28: 299-323
• 44 Tesarz J, Schuster AK, Hartmann M, Gerhardt A, Eich W. Pain perception in athletes compared to normally active controls: A systematic review with meta-analysis. Pain 2012; 153: 1253-1262
• 45 Tousignant-Laflamme Y, Pagé S, Goffaux P, Marchand S. An experimental model to measure excitatory and inhibitory pain mechanisms in humans. Brain Res 2008; 1230: 73-79
• 46 Vaegter HB, Handberg G, Graven-Nielsen T. Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain 2014; 155: 158-167
• 47 Vaegter HB, Handberg G, Jørgensen MN, Kinly A, Graven Nielsen T. Aerobic exercise and cold pressor test induce hypoalgesia in active and inactive men and women. Pain Med 2015; 16: 923-933
• 48 Vanderah TW, Gardell LR, Burgess SE, Ibrahim M, Dogrul A, Zhong C-M, Zhang E-T, Malan TP, Ossipov MH, Lai J. Dynorphin promotes abnormal pain and spinal opioid antinociceptive tolerance. J Neurosci 2000; 20: 7074-7079
• 49 Vanderah TW, Suenaga NM, Ossipov MH, Malan TP, Lai J, Porreca F. Tonic descending facilitation from the rostral ventromedial medulla mediates opioid-induced abnormal pain and antinociceptive tolerance. J Neurosci 2001; 21: 279-286
• 50 Vierck CJ, Staud R, Price DD, Cannon RL, Mauderli AP, Martin AD. The effect of maximal exercise on temporal summation of second pain (windup) in patients with fibromyalgia syndrome. J Pain 2001; 2: 334-344
• 51 Villanueva L, Bouhassira D, Le Bars D. The medullary subnucleus reticularis dorsalis (SRD) as a key link in both the transmission and modulation of pain signals. Pain 1996; 67: 231-240
• 52 Willer JC, Le Bars D, De Broucker T. Diffuse noxious inhibitory controls in man: involvement of an opioidergic link. Eur J Pharmacol 1990; 182: 347-355
• 53 Yarnitsky D. Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states. Curr Opin Anesthesiol 2010; 23: 611-615
• 54 Yarnitsky D, Bouhassira D, Drewes A, Fillingim R, Granot M, Hansson P, Landau R, Marchand S, Matre D, Nilsen K. Recommendations on practice of conditioned pain modulation (CPM) testing. Eur J Pain 2015; 19: 805-806