Notes from the lecture “Pain and Hypertension: An Integrated Approach to Treatment” Wykład wygłoszony podczas XII Zjazdu Polskiego Towarzystwa Badania Bólu 2025, który odbył się 16–18 października we Wrocławiu oraz w Internecie w portalu Medycyny Praktycznej
Article Sidebar
Published:
Mar 1, 2026
Keywords:
syndemic, chronic pain, hypertension, naproxen, diclofenac, multimodal treatment
Main Article Content
Abstract
Chronic pain and hypertension form a syndemic, common conditions that reinforce each other, including through chronic inflammation and sympathetic nervous system activation. Chronic pain, especially when multi-sited, significantly increases the risk of cardiovascular disease (heart attack, stroke). Pharmacological pain management is challenging because nonsteroidal anti-inflammatory drugs (NSAIDs) can increase blood pressure and weaken the effectiveness of some antihypertensive medications. Among traditional NSAIDs, naproxen demonstrates the most favorable cardiovascular profile (especially at doses <750 mg/24 h), while diclofenac is contraindicated in patients with diagnosed cardiovascular disease (heart failure, myocardial infarction, stroke). In primary care, routine pain assessment and multimodal treatment, combined with informed selection and monitoring of drug side effects and interactions, are crucial.
Article Details
How to Cite
Kocot-Kępska, M. (2026). Notes from the lecture “Pain and Hypertension: An Integrated Approach to Treatment” . Medycyna Faktow (J EBM), 19(4(69), 483-487. https://doi.org/10.24292/01.MF.0425.01
Issue
Section
Articles
Copyright by Medical Education. All rights reserved.
References
1. Breivik H, Collett B, Ventafridda B et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006; 10(4): 287-333.
2. Kocot-Kepska M, Dobrogowski J. Ocena badan epidemiologicznych dotyczacych bólu przewlekłego nienowotworowego prowadzonych w Europie w 2002 roku przez Mundipharma. Ból 2004, 3: 18-24.
3. Giummarra MJ, Tardif H, Blanchard M et al. Hypertension prevalence in patients attending tertiary pain management services, a registry-based Australian cohort study. PLoS ONE 2020; 15(1): e0228173.
4. Bruehl S, Chung OY, Jirjis JN et al. Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients. Clin J Pain. 2005; 21(2): 147-53.
5. Raport NFZ. Nadciśnienie tętnicze. 17.05.2019.
6. Li CY, Lin WC, Lu CY et al. Prevalence of pain in community-dwelling older adults with hypertension in the United States. Sci Rep. 2022; 12(1): 8387.
7. Mendoza R, Hensley C, Ryan J et al. Rehabilitation management of the chronic pain-hypertension synergy: Proposal of an evidence-informed framework. Braz J Phys Ther. 2025; 29(5): 101229.
8. Pfoh ER, Chatoff AM, Martinze K et al. Association Between Pain, Blood Pressure, and Medication Intensification in Primary Care: an Observational Study. J Gen Intern Med. 2020; 35(12): 3549-55.
9. Tian J, Shen Z, Sutherland BA et al. Chronic pain in multiple sites is associated with cardiovascular dysfunction: an observational UK Biobank cohort study. Br J Anaesth. 2024; 133(3): 605-14.
10. Chen Y, Chen F, Chen W et al. Chronic pain and incident hypertension: an observational study of 0.4 million adults. J Health Popul Nutr. 2025; 44(1): 325.
11. Rönnegård AS, Nowak C, Äng B, Ärnlöv J. The association between short-term, chronic localized and chronic wide spread pain and risk for cardiovascular disease in the UK Biobank. Eur J Prev Cardiol. 2022; 29(15): 1994-2002.
12. Entonen AH, Suominen SB, Sillanmaki NH et al. Prevalentmigraine as apredictor of incidenthypertension. Eur J Public Health. 2022; 32(2): 297-301.
13. Rivasi G, Menale S, Turrin G et al. The Effects of Pain and Analgesic Medications on Blood Pressure. Curr Hypertens Rep. 2022; 24(10): 385-94.
14. Cabassi A, Tedeschi S, Perlini S et al. Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice. Eur J Prev Cardiol. Eur J Prev Cardiol. 2020; 27(8): 850-67.
15. New safety advice for diclofenac - CMDh endorses PRAC recommendation. 28 June 2013. European Medicines Agency Science Medicines Health. EMA/592685/2013.
16. Charakterystyka produktu leczniczego Nalgesin, 275 mg, tabletki powlekane. 08.08.2024.
17. Grosser T, Ricciotti E, Fitzgerald GA. The Cardiovascular Pharmacology of Nonsteroidal Anti-Inflammatory Drugs. Trends Pharmacol Sci. 2017; 38(8): 733-48.
18. Van Hecken A, Schwartz JI, Depré M et al. Comparative inhibitory activity of rofecoxib, meloxicam, diclofenac, ibuprofen, and naproxen on COX-2 versus COX-1 in healthy volunteers. J Clin Pharmacol. 2000; 40(10): 1109120.
19. Shahid W, Ejaz SA, Al.-Rashida M et al. Identification of NSAIDs as lipoxygenase inhibitors through highly sensitive chemiluminescence method, expression analysis in mononuclear cells and computational studies. Bioorg Chem. 2021; 110: 104818.
20. Tahami SM, Aminian A, Azarpira N et al. Experimental Study on Protective Role of NSAID on Articular Cartilage Destruction in Septic Arthritis. Arch Bone Jt Surg. 2020; 8(1): 89-93.
21. Hautaniemi T, Petrenko N, Skorinkin Aet al. The inhibitory action of the antimigraine nonsteroidal anti-inflammatory drug naproxen on P2X3 receptor-mediated responses in rat trigeminal neurons. Neuroscience. 2012; 209: 32-38.
22. Coxib and traditional NSAID Trialists’ (CNT) Collaboration; Bhala N, Emberson J, Merhi Aet al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013; 382(9894): 769-79.
2. Kocot-Kepska M, Dobrogowski J. Ocena badan epidemiologicznych dotyczacych bólu przewlekłego nienowotworowego prowadzonych w Europie w 2002 roku przez Mundipharma. Ból 2004, 3: 18-24.
3. Giummarra MJ, Tardif H, Blanchard M et al. Hypertension prevalence in patients attending tertiary pain management services, a registry-based Australian cohort study. PLoS ONE 2020; 15(1): e0228173.
4. Bruehl S, Chung OY, Jirjis JN et al. Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients. Clin J Pain. 2005; 21(2): 147-53.
5. Raport NFZ. Nadciśnienie tętnicze. 17.05.2019.
6. Li CY, Lin WC, Lu CY et al. Prevalence of pain in community-dwelling older adults with hypertension in the United States. Sci Rep. 2022; 12(1): 8387.
7. Mendoza R, Hensley C, Ryan J et al. Rehabilitation management of the chronic pain-hypertension synergy: Proposal of an evidence-informed framework. Braz J Phys Ther. 2025; 29(5): 101229.
8. Pfoh ER, Chatoff AM, Martinze K et al. Association Between Pain, Blood Pressure, and Medication Intensification in Primary Care: an Observational Study. J Gen Intern Med. 2020; 35(12): 3549-55.
9. Tian J, Shen Z, Sutherland BA et al. Chronic pain in multiple sites is associated with cardiovascular dysfunction: an observational UK Biobank cohort study. Br J Anaesth. 2024; 133(3): 605-14.
10. Chen Y, Chen F, Chen W et al. Chronic pain and incident hypertension: an observational study of 0.4 million adults. J Health Popul Nutr. 2025; 44(1): 325.
11. Rönnegård AS, Nowak C, Äng B, Ärnlöv J. The association between short-term, chronic localized and chronic wide spread pain and risk for cardiovascular disease in the UK Biobank. Eur J Prev Cardiol. 2022; 29(15): 1994-2002.
12. Entonen AH, Suominen SB, Sillanmaki NH et al. Prevalentmigraine as apredictor of incidenthypertension. Eur J Public Health. 2022; 32(2): 297-301.
13. Rivasi G, Menale S, Turrin G et al. The Effects of Pain and Analgesic Medications on Blood Pressure. Curr Hypertens Rep. 2022; 24(10): 385-94.
14. Cabassi A, Tedeschi S, Perlini S et al. Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice. Eur J Prev Cardiol. Eur J Prev Cardiol. 2020; 27(8): 850-67.
15. New safety advice for diclofenac - CMDh endorses PRAC recommendation. 28 June 2013. European Medicines Agency Science Medicines Health. EMA/592685/2013.
16. Charakterystyka produktu leczniczego Nalgesin, 275 mg, tabletki powlekane. 08.08.2024.
17. Grosser T, Ricciotti E, Fitzgerald GA. The Cardiovascular Pharmacology of Nonsteroidal Anti-Inflammatory Drugs. Trends Pharmacol Sci. 2017; 38(8): 733-48.
18. Van Hecken A, Schwartz JI, Depré M et al. Comparative inhibitory activity of rofecoxib, meloxicam, diclofenac, ibuprofen, and naproxen on COX-2 versus COX-1 in healthy volunteers. J Clin Pharmacol. 2000; 40(10): 1109120.
19. Shahid W, Ejaz SA, Al.-Rashida M et al. Identification of NSAIDs as lipoxygenase inhibitors through highly sensitive chemiluminescence method, expression analysis in mononuclear cells and computational studies. Bioorg Chem. 2021; 110: 104818.
20. Tahami SM, Aminian A, Azarpira N et al. Experimental Study on Protective Role of NSAID on Articular Cartilage Destruction in Septic Arthritis. Arch Bone Jt Surg. 2020; 8(1): 89-93.
21. Hautaniemi T, Petrenko N, Skorinkin Aet al. The inhibitory action of the antimigraine nonsteroidal anti-inflammatory drug naproxen on P2X3 receptor-mediated responses in rat trigeminal neurons. Neuroscience. 2012; 209: 32-38.
22. Coxib and traditional NSAID Trialists’ (CNT) Collaboration; Bhala N, Emberson J, Merhi Aet al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013; 382(9894): 769-79.