CENTRAL MODULATION OF PAIN PERCEPTION IN PATIENTS WITH SILENT-MYOCARDIAL-ISCHEMIA

Since the results of somatosensory-evoked potentials do not suggest any difference between patients with symptomatic and silent myocardial ischemia in conduction of electrical stimuli to the sensory cortex, the abnormality in pain tolerance in patients with silent ischemia is likely related to the patient's ability to recognize or respond to incoming stimulus as a painful one. Whether this ability to recognize a painful stimulus is at a conscious or subconscious level could not be addressed in this study. Previous studies dealing with patients' reporting of symptoms16-19 suggest that patients with silent myocardial ischemia are less likely to report painful stimuli in general, as compared with patients with symptomatic myocardial ischemia. The most probable explanation is that a combination of multiple factors, such as individual patient characteristics (age, gender, ethnic background, etc.), the severity of myocardial ischemia, and the external and internal milieu at the time of the ischemic episode, may influence whether an episode of myocardial ischemia results in symptoms. © 1994.