Association of genetic and psychological factors with persistent pain after cosmetic thoracic surgery

Abstract

The genetic control of pain has been repeatedly demonstrated in human association studies. In the present study, we assessed the relative contribution of 16 single nucleotide polymorphisms in pain-related genes, such as cathechol-O-methyl transferase gene (COMT), fatty acid amino hydrolase gene (FAAH), transient receptor potential cation channel, subfamily V, member 1 gene (TRPV1), and δ-opioid receptor gene (OPRD1), for postsurgical pain chronification. Ninety preoperatively pain-free male patients were assigned to good or poor outcome groups according to their intensity or disability score assessed at 1 week, 3 months, 6 months, and 1 year after funnel chest correction. The genetic effects were compared with those of two psychological predictors, the attentional bias toward positive words (dot-probe task) and the self-reported pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), which were already shown to be the best predictors for pain intensity and disability at 6 months after surgery in the same sample, respectively. Cox regression analyses revealed no significant effects of any of the genetic predictors up to the end point of survival time at 1 year after surgery. Adding the genetics to the prediction by the attentional bias to positive words for pain intensity and the PVAQ for pain disability, again no significant additional explanation could be gained by the genetic predictors. In contrast, the preoperative PVAQ score was also, in the present enlarged sample, a meaningful predictor for lasting pain disability after surgery. Effect size measures suggested some genetic variables, for example, the polymorphism rs1800587G>A in the interleukin 1 alpha gene (IL1A) and the COMT haplotype rs4646312T>C/rs165722T>C/rs6269A>G/rs4633T>C/rs4818C>G/rs4680A>G, as possible relevant modulators of long-term postsurgical pain outcome. A comparison between pathophysiologically different predictor groups appears to be helpful in identifying clinically relevant predictors of chronic pain.

Association between COMT Polymorphism Val158Met and Opioid Consumption in Patients with Postoperative Pain: A Meta-Analysis

“…COMT gene has four important SNPs: rs4680, rs6269, rs4633 and rs4818, all of which produce three pain sensitivity haplotypes: HPS, APS, and LPS. The present study failed to obtain an exclusive conclusion, but the correlation between the haplotype and opioid consumption cannot be ignored [12,25,[32][33][34]45]. Furthermore, some recent studies have begun to explore the relationship between genegene (COMT and OPRM1) interactions to the pain susceptibility and opioid analgesic effect.…”

“…In contrast, the results form Orrey and Kolesnikov suggested that patients without LPS haplotype had maximum pain and would require a higher opioid amount [21,32]. Meanwhile, APS haplotype might associate with the lowest pain perception but involve long-term postsurgical pain [33,34]. Besides the haplotype of COMT, the interaction between OPRM1, sex, and COMT may also affect patients' pain perception [12,35].…”

Prediction of persistent post‐operative pain: Pain‐specific psychological variables compared with acute post‐operative pain and general psychological variables

“…Pain catastrophizing has turned out as relevant predictor in several studies (Edwards et al, 2009;Theunissen et al, 2012;Masselin-Dubois et al, 2013;Schreiber et al, 2013;Burns et al, 2015) and is also increasingly acknowledged as psychological risk factor in comprehensive reviews (Niraj and Rowbotham, 2011;Chapman and Vierck, 2017). However, pain anxiety and pain hypervigilance have to date rarely been tested (Lautenbacher et al, 2010;Dimova et al, 2015). In addition, depression and anxiety are still highlighted as the main psychological factors implicated in the transition from acute to chronic post-operative pain (Hinrichs-Rocker et al, 2009;Chapman and Vierck, 2017).…”

“…Self-rated pain intensity and pain-related disability were assessed in the first post-operative session (T1; acute pain, predictor) and again in the second post-operative session (T2; chronic pain, outcome). This study was part of a larger prospective study also including additional predictors such as experimental pain testing and cortisol levels which are not reported here (Lautenbacher et al, 2009(Lautenbacher et al, , 2010Dimova et al, 2015). The PCS (Sullivan et al, 1995) was developed as a measure of catastrophizing related to pain.…”

“…However, other pain-specific variables (e.g. pain anxiety, pain hypervigilance) have been rarely investigated and post-operative assessment of psychological variables is uncommon (Lautenbacher et al, 2010;Dimova et al, 2015). In addition, stateof-the-art reviews still stress the major importance of more general psychological variables such as anxiety and depression (Kehlet et al, 2006;Macrae, 2008;Hinrichs-Rocker et al, 2009;Katz and Seltzer, 2009;Voscopoulos and Lema, 2010;Chapman and Vierck, 2017) with neglect of the high predictive value of pain-specific psychological variables (Lautenbacher et al, 2009(Lautenbacher et al, , 2010Scheel et al, 2017).…”