Psychosomatic Medicine
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Published online before print August 31, 2007, 10.1097/PSY.0b013e318151a4bd
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An Interactive Model of Pain and Myocardial Ischemia

Susan E. Hofkamp, PhD, Charles A. Henrikson, MD and Stephen T. Wegener, PhD

From the Department of Physical Medicine and Rehabilitation (S.E.H., S.T.W.); Department of Medicine (C.A.H.), Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.


Figure 17
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  		Figure 1. This model shows the likely determinants of painful versus silent ischemic episodes. Biopsychosocial risk factors likely interact with coronary artery disease diagnosis and presence of ischemia to determine the variability of pain reporting with ischemic episodes. TABP = Type A behavior pattern; mechanical factors = spasm and distension of cardiac vessels; chemical factors = lactic acid, potassium ions, kinins, and other pain-producing substances, adenosine, and endogenous opioids.

 




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