Beta-endorphin response to exercise and mental stress in patients with ischemic heart disease☆

The relationship of cardiovascular events and cardiovascular symptoms is unclear, and physical symptoms, including most cardiovascular symptoms, are known to be influenced by emotional distress.

Authors examined the relative strength of association of multiple measures of emotional distress and accepted cardiac risk factors with five common cardiac symptoms (chest pain, fatigue, palpitations, presyncope, and dyspnea).

The authors tested the association of multiple cardiovascular symptoms with various measures of emotional distress (i.e., the scales of the Symptom Checklist-90–Revised) and the putative risk factors for disease status in 109 patients with documented coronary artery disease.

Measures of emotional distress were stronger correlates of patient-rated distress due to the symptoms than were traditional risk factors.

Treatment of emotional distress may be a viable strategy for symptom-control in cardiovascular disease.

The anger management styles of anger-in (inhibition) and anger-out (direct expression) are positively associated with pain responsiveness. Opioid blockade studies suggest that hyperalgesic effects of trait anger-out, but not those of trait anger-in, are mediated in part by opioid analgesic system dysfunction. The current study tested the opioid dysfunction hypothesis of anger-out using an alternative index of opioid function: pain-induced changes in plasma endogenous opioids. Plasma beta-endorphin (BE) was assessed at rest and again following exposure to three laboratory acute pain tasks (finger pressure, ischemic, and thermal) in 14 healthy controls and 13 chronic low back pain (LBP) subjects. As expected, acute pain ratings correlated positively with measures of anger-in (both groups) and anger-out (LBP group; p’s < .05). Greater pain-induced increases in BE were associated with significantly lower pain ratings in both groups (p’s < .05). Hierarchical multiple regression indicated that greater anger-out significantly predicted smaller pain-induced BE increases (p < .05). Subject type did not moderate this association (p > .10). Anger-in did not display significant main or interaction effects on pain-induced BE changes (p’s > .10). The significant association between anger-out and BE release partially mediated the hyperalgesic effects of anger-out on pain unpleasantness, and was not attenuated by statistical control of general negative affect. This suggests unique associations with expressive anger regulation. Elevated trait anger-out therefore appears to be associated with opioid analgesic system dysfunction, whether it is indexed by responses to opioid blockade or by examining circulating endogenous opioid levels. Possible “state × trait” interactions on these anger-related opioid system differences are discussed.

Muchos psicólogos deportivos recomiendan escuchar música como parte de la preparación mental del deportista a la competición. ¿Puede esto hacernos pensar que la música tenga un cierto efecto ergogénico? Relacionar música y deporte ha despertado interés desde hace muchos años; sin embargo, hoy por hoy, los hallazgos son todavía contradictorios. Parece haberse demostrado la utilidad de la música como ayuda al aprendizaje y al perfeccionamiento de habilidades motoras y, en el ámbito hospitalario, a la reducción de la ansiedad y el estrés ante varias enfermedades y diversas pruebas diagnósticas de carácter invasivo. En lo que sí parecen estar de acuerdo todos los estudios es en la ausencia de un efecto ergogénico de la música per se. Varios trabajos abogan por la importancia del ritmo de la música para aumentar el rendimiento deportivo, dado que parece existir una predisposición innata en el hombre a sincronizar movimientos, con lo que, ayudados por un ritmo musical alto (> 100 bpm), los actos motores serían más eficientes y, en consecuencia, podría mejorarse el rendimiento físico. Prácticamente la totalidad de los estudios coinciden en la capacidad de la música para disuadir estímulos externos y focalizar la atención del sujeto en la tarea física que está ejecutando, a la vez que minimiza la sensación de fatiga que acompaña al ejercicio. También se relata la importancia de que la música suscite una vivencia extramusical y una asociación deportiva por parte del individuo y no necesariamente debiera tratarse de una música “conocida” por el deportista. Es difícil hallar en la literatura científica trabajos estructurados de manera similar, por lo que muchas variables artefactan la comparación adecuada entre los estudios publicados. Hoy por hoy, cuánto de ergogénico posee la música realmente no parece tener aún respuesta, pese a que parecen haber evidencias suficientes para contemplarla como un arma psicológica.

Many sports psychologists recommend listening to music to prepare mentally before a competition, suggesting that music might have an ergogenic effect. The relation between music and sport has aroused interest for many years; however current findings are still contradictory. The utility of music as an aid to learning and improving motor skills and, in the hospital environment, for anxiety and stress reduction in some diseases and invasive diagnostic tests seems to have been demonstrated. All studies seem to agree on the absence of an ergogenic effect of music per se. Several studies support the importance of music's rhythm in increasing sports performance since humans seem to have an innate predisposition to synchronize movements and therefore, a quick rhythm (>100 bpm) could increase the efficiency of motor skills and consequently, improve physical performance. Most studies agree on the ability of music to block out external stimuli, focus the individual's attention on the physical task being performed, and minimize the fatigue accompanying exercise. Also important is the ability of music to evoke non-musical, sports-related associations and the fact that the music need not be familiar to the individual. Few studies in the literature have a similar structure, hampering comparisons among them. Currently, the extent to which music has ergogenic properties remains unclear, although there is sufficient evidence to support its use as a psychologist aid.

The role of emotional distress (e.g., anger, depression, and anxiety) in anginal chest discomfort (ACD) may have been underestimated. The authors review the empirical studies in this area, which are inconsistent with the standard theory on the ischemia-angina relationship; summarize the substantial evidence indicating a strong and consistent cross-sectional/prospective epidemiological association of emotional distress and ischemia/ACD; review the distress-targeted, interventional evidence confirming a causal relationship (i.e., reduced chest discomfort and health system utilization), thus confirming clinical utility of such interventions; and explore the possible mechanisms that might account for the relationship between emotional distress and chest discomfort. Substantial clinical benefit may be achieved by aggressively detecting and treating emotional distress in ACD patients.

A number of endogenous mediators, including opioids, adenosine and bradykinin, which act on cardiac cell membrane receptors have been demonstrated to trigger the phenomenon termed ischemic preconditioning (IPC). IPC is an endogenous protective mechanism, whereby a brief period of ischemia or hypoxia protects a cell or organ, in this review the heart, against injury from a subsequent more prolonged stressful insult. Recent data suggest that opioid receptors are important triggers and/or mediators of this protective response. Selective pharmacological antagonists of the δ-or κ-opioid receptor have been shown to block IPC, and agonists of these same receptors have been shown to mimic IPC in intact animals, isolated hearts or isolated cardiomyocytes. This review will summarize the current state of knowledge, which exists defining the role and cellular signaling pathways by which endogenously or exogenously administered opioids produce their cardioprotective response. The potential clinical application and evidence to suggest that opioids produce a similar protective effect in man will also be discussed.