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ANALGESIA

Experimental Heat Pain for Detecting Pregnancy-Induced Analgesia in Humans

Brendan Carvalho, MBBCh, FRCA^*, Martin S. Angst, MD^*, Andrea J. Fuller, MD, Eric Lin, MD, Anbu D. Mathusamy, MD, and Edward T. Riley, MD^*

From the *Department of Anesthesia, Stanford University School of Medicine, Stanford, Californi; at Northern Colorado Anesthesia Professional Consultants, Fort Collins, Colorado; University of California San Francisco, San Francisco, California; and Bronx-Lebanon Hospital, Bronx, New York.

Address correspondence and reprint requests to Brendan Carvalho, MBBCh, FRCA, Department of Anesthesia, H3580, Stanford University School of Medicine, Stanford, CA 94305. Address e-mail to bcarvalho{at}stanford.edu.

Abstract

Animal studies suggest that increased circulating estrogen and progesterone, and activation of the endorphin system cause prenancy-induced antinociceptive effects. Human studies have provided inconsistent results and have often lacked a nonpregnant control group. In this study, we compared sensitivity to experimental heat and cold pain in pregnant and nonpregnant women. Nineteen healthy nonpregnant female volunteers and 20 pregnant women at term were enrolled. Pain threshold and tolerance were examined using experimental heat-induced pain and cold pressor pain models. Subjects were evaluated pre- and 1–2 days post-delivery (pregnant), or on consecutive days (nonpregnant). Heat pain tolerance was significantly increased in the pregnant women during pre and postdelivery when compared with nonpregnant controls (50.0 ± 1.0 vs 49.0 ± 1.2 and 50.1 ± 0.7 vs 49.2 ± 1.2°C; mean ± sd). However, pain induced by the cold pressor test was endured for a similar amount of time by both study groups. Pregnancy-induced analgesic effects at term can be detected in a model of experimental heat pain. These effects persist during the first 24–48 h after delivery. Experimental heat pain is a suitable modality for further characterizing the phenomenon of pregnancy-induced analgesia in humans.