Abstract
A hydrostatic rise in forearm vascular transmural pressure may be associated with an increase in forearm blood flow (FBF) that causes pain. To test this hypothesis, forearm vascular transmural pressure was elevated in eight male volunteers by a series of 1-min hypobaric exposures of the left arm to incrementing differential pressures of 40, 80, 120, 140, 160 and 200 mmHg. The series was repeated after a 30-min interval. Forearm venous pressure (FVP) was measured in the median antecubital vein, and FBF was determined by ultrasound Doppler in the axillary artery. Pain level was recorded by numerical rating scale. In all subjects, an increase in FBF and forearm vascular conductance (FVC) occurred (P < 0.05) at high FVP (mean ± SE, 184 ± 8 mmHg). Pain was linearly related to the increase in FVC. In the second series of exposures, increases in FBF, FVC and pain occurred at a lower transmural pressure (FVP 152 ± 15 mmHg, P < 0.01). It is concluded that intense forearm pain is associated with a failure of autoregulation in the peripheral vascular bed and is worsened on repeated exposure to high transmural pressure. This may explain the overt forearm pain experienced by the crews of high performance military aircraft during manoeuvring.
Similar content being viewed by others
References
Arndt JO, Klement W (1991) Pain evoked by polymodal stimulation of hand veins in humans. J Physiol 440:467–478
Bayliss WM (1902) On the local reactions of the arterial wall to changes of internal pressure. J Physiol 28:220–231
Benjamin N, Calver A, Collier J, Robinson B, Vallance P, Webb D (1995) Measuring forearm blood flow and interpreting the responses to drugs and mediators. Hypertension 25:918–923
Borg G, Holmgren A, Lindblad I (1981) Qualitative evaluation of chest pain. Acta Med Scand Suppl 644:43–45
Brown E, Greenfield ADM, Goei JS, Plassaras G (1966) Filling and emptying the low-pressure blood vessels of the human forearm. J Appl Physiol 21:573–582
Buckey JC, Peshock RM, Blomqvist CG (1988) Deep venous contribution to hydrostatic blood volume change in the human leg. Am J Cardiol 62:449–453
Coles DR, Greenfield ADM (1956) The reactions of the blood vessels of the hand during increases in transmural pressure. J Physiol 131:227–289
Eiken O, Kolegard R (2004) Comparison of vascular distensibility in the upper and lower extremity. Acta Physiol Scand 181:281–287
Ernsting J (1966) Some effects of raised intrapulmonary pressure in man. PhD thesis, University of London
Friden J, Sjostrom M, Ekblom B (1981) A morphological study of delayed muscle soreness. Experientia 37:506–507
Fruhstorfer H, Lindblom U (1983) Vascular participation in deep cold pain. Pain 17:235–241
Gamble J, Gartside IB, Christ F (1993) A reassessment of mercury in silastic strain gauge plethysmography for microvascular permeability assessment in man. J Physiol 464:407–422
Green NDC (1997) Arm arterial occlusion cuffs as a means of alleviating high +Gz-associated arm pain. Aviat Space Environ Med 68(8):715–721
Greenfield ADM, Patterson GC (1954) Reactions of the blood vessels of the human forearm to increases in transmural pressure. J Physiol 125:508–524
Halpern EJ, Merton DA, Forsberg F (1998) Effect of distal resistance on doppler US flow pattterns. Radiology 206:761–766
Holthusen H, Arndt JO (1995) Nitric oxide evokes pain at nociceptors of the paravascular tissue and veins in humans. J Physiol 487(Pt 1):253–258
Hudlicka O (1973) Muscle blood flow. Its relation to muscle metabolism and function. Swets & Zeitlinger BV, Amsterdam
Ireland MA, Davies P, Littler WA (1983) Some aspects of the arterial response to venous occlusion in man. Clin Sci 65:1–8
Kindgen-Milles D, Arndt JO (1996) Nitric oxide as a chemical link in the generation of pain from veins in humans. Pain 64(1):139–142
Lautt WW (1989) Resistance or conductance for expression of arterial vascular tone. Microvasc Res 37:230–236
Lewis MT, Green NDC, Adcock TR, Peterson MK, Prior ARJ (1995) In-flight assessment of arm pain at high G. RAF School of Aviation Medicine, Ministry of Defence, London
Linde L, Balldin U (1998) Arm pain among Swedish fighter pilots during high +Gz flight and centrifuge exposures. Aviat Space Environ Med 69(7):639–642
Norris CS, Barnes RW (1984) Renal artery flow velocity analysis: a sensitive measure of experimental and clinical renovascular resistance. J Surg Res 36:230–236
O’Leary DS (1991) Regional vascular resistance vs conductance: which index for baroreflex responses? Am J Physiol Heart Circ Physiol 260:H632–H637
Osol G, Brekke JF, McElroy-Yaggy K, Gokina NI (2002) Myogenic tone, reactivity, and forced dilatation: a three-phase model of in vitro arterial myogenic behavior. Am J Physiol Heart Circ Physiol 283:H2260–H2267
Prior ARJ, Tozer A (1992) Arm pain associated with positive pressure breathing for +Gz acceleration protection (abstract). Aviat Space Environ Med 63:400
Schubert R, Mulvany MJ (1999) The myogenic response: established facts and attractive hypotheses. Clin Sci 96:313–326
Spencer JAD, Giussani DA, Moore PJ, Hanson MA (1991) In vitro validation of doppler indices using blood and water. J Ultrasound Med 10:305–308
Whitney RJ (1953) The measurement of volume changes in human limbs. J Physiol 121:1–27
Wooley CF, Sparks EH, Boudoulas H (1998) Aortic pain. Prog Cardiovasc Dis 40(6):563–589
Acknowledgments
We would like to thank the staff at the RAF Centre of Aviation Medicine for their technical assistance and the subjects for their time and cooperation. British Crown copyright 2006/MOD.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Green, N.D.C., Brown, M.D. & Coote, J.H. Pain and changes in peripheral resistance at high vascular transmural pressure in the human forearm. Eur J Appl Physiol 100, 627–635 (2007). https://doi.org/10.1007/s00421-007-0466-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00421-007-0466-z