Highlights
- •Distress increases tonic sympathetic pupillary drive during cold pressor tests.
- •Pain increases phasic sympathetic pupillary drive during cold pressor tests.
- •Phasic influences persist whereas tonic influences decline during repeated tests.
- •Phasic and tonic effects may reflect different aspects of locus coeruleus function.
- •Both effects should be assessed in patients with suspected locus coeruleus deficits.
Abstract
Nociceptive and affective stimuli increase reflex sympathetic outflow to the pupils.
To investigate effects of stimulus intensity, unpleasantness and distress on these
pupillary reflexes, and to assess their stability, healthy participants immersed their
hand in ice-water three times (for 20, 40 and 60 s; or 60, 40 and 20 s; or three times
for 60 s) (N = 21 in each condition). Each ice-water immersion was preceded by a 90 s warm water
immersion. To evaluate phasic sympathetic influences on pupil diameter, pupillary
re-dilatation after 1 s of bright light was assessed during the last 10 s of each
immersion. By-and-large, pain ratings and pupil diameter were greater during longer
than shorter ice-water immersions, and ice-water immersions facilitated pupillary
re-dilatation after the flash stimulus. However, mean pupil diameter during ice- and
warm water immersions, minor ipsilateral amplification of the pupillary response,
and ratings of pain unpleasantness and distress decreased across the experiment. Together,
these findings suggest that nociceptive input increased sympathetic pupillary tone
and amplified phasic increases in sympathetic activity after exposure to light. However,
tonic sympathetic influences on pupil diameter and lateralization decreased across
repeated immersions, possibly as novel or threatening aspects of the experience declined.
Pupillary nociceptive and affective reflexes involve the locus coeruleus, an integral
component of neural circuits that heighten cortical arousal and regulate pain. As
these reflexes appear to reflect different aspects of sensory and affective processing,
their combined assessment might increase the sensitivity and specificity of tests
of locus coeruleus function in patients with suspected deficits.
Keywords
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Article info
Publication history
Published online: March 15, 2023
Accepted:
March 10,
2023
Received in revised form:
February 28,
2023
Received:
December 14,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
