Biopsychosocial Influence on Exercise-induced Delayed Onset Muscle Soreness at the Shoulder: Pain Catastrophizing and Catechol-O-Methyltransferase (COMT) Diplotype Predict Pain Ratings

Abstract

Objective-The experience of pain is believed to be influenced by psychologic and genetic factors. A previous study suggested pain catastrophizing and catechol-O-methyltransferase (COMT) genotype influenced clinical pain ratings for patients seeking operative treatment of shoulder pain. This study investigated whether these same psychologic and genetic factors predicted responses to induced shoulder pain.Methods-Participants (n=63) completed self-report questionnaires and had COMT genotype determined before performing a standardized fatigue protocol to induce delayed onset muscle soreness. Then, shoulder pain ratings, self-report of upper-extremity disability ratings, and muscle torque production were reassessed 24, 48, and 72 hours later.Results-This cohort consisted of 35 women and 28 men, with a mean age of 20.9 years (SD=1.7). The frequency of COMT diplotypes was 42 with "high COMT enzyme activity" (low pain sensitivity group) and 21 with "low COMT enzyme activity" (average pain sensitivity/high pain sensitivity group). A hierarchical regression model indicated that an interaction between pain catastrophizing and COMT diplotype was the strongest unique predictor of 72-hour pain ratings. The same interaction was not predictive of self-report of disability or muscle torque production at 72 hours. The pain catastrophizing × COMT diplotype interaction indicated that participants with high pain catastrophizing and low COMT enzyme activity (average pain sensitivity/high pain sensitivity group) were more likely (relative risk=3.5, P=0.025) to have elevated pain intensity ratings (40/100 or higher).Reprints: Steven Z. George, PT, PhD, Department of Physical Therapy, Brooks Center for Rehabilitation Studies, University of Florida, Health Science Center, PO Box 100154, Gainesville, FL 32610-0154 (e-mail: E-mail: szgeorge@phhp.ufl.edu). NIH Public Access Author ManuscriptClin J Pain. Author manuscript; available in PMC 2009 April 16. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptDiscussion-These findings from an experimental model converge with those from a surgical cohort and provide additional evidence that the presence of elevated pain catastrophizing and COMT diplotype indicative of low COMT enzyme activity have the potential to increase the risk of developing chronic pain syndromes.Keywords biopsychosocial model; chronic pain; catastrophizing; COMT genotype; shoulder pain; delayed onset muscle sorenessThe experience of pain varies considerably among individuals. Social, cultural, environmental, psychologic, and genetic factors are all believed to contribute to this variability. A model for the development of idiopathic pain conditions that takes into consideration these sources of variability was recently proposed. 1 In this model, it is suggested that high levels of psychologic distress and pain amplification (ie, genetic predisposition for biologic or physiologic processes) are the primary factors contributing to the development of idiopathic pain conditions. 1Few studies to da...

Heritability of catastrophizing

“…Importantly, COMT genotype and catastrophizing were not related. They have subsequently replicated these findings in a separate clinical cohort and in two additional cohorts experiencing experimentally-induced shoulder pain [7; 8]. The findings of Trost and colleagues of a genetic contribution to catastrophizing opens the possibility that the COMT X catastrophizing interaction may represent a gene-gene interaction in addition to a gene-environment interaction.…”

Research design considerations for chronic pain prevention clinical trials

“…For example, previous studies have reported that COMT, OPRM1 , and GCH1 show sex-specific associations with pain responses [14,15,124]. In addition, COMT haplotypes have been shown to interact with psychological functioning (i.e., pain catastrophizing) to predict both experimental and clinical shoulder pain outcomes [58,60]. Research has shown that OPRM1 and COMT exerted combined effects on the total dosage of morphine consumed by patients with chronic cancer-related pain [138].…”

Genetic Contribution of Catechol-O-Methyltransferase Polymorphism (Val158Met) in Children With Chronic Tension-Type Headache

“…Immediately after collection, samples were centrifuged at 3000 rpm for 15 min to obtain the cell sediment and they were stored at Ϫ20°C until main analysis. We prefer to use saliva instead of blood sampling because salivary collection is a noninvasive, stress-free, and ethic suitable assessment method for children which has been previously used (22,23).…”