Genetics of Pain Perception,
            <i>COMT</i>
            and Postoperative Pain Management in Children

Sadhasivam, Senthilkumar; Chidambaran, Vidya; Olbrecht, Vanessa A.; Esslinger, Hope; Zhang, Kejian; Zhang, Xue; Martin, Lisa J.

doi:10.2217/pgs.13.248

Cited by 75 publications

(48 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…38 Specifically, rs6269 is in the promoter region of the soluble isoform of the gene and thus could theoretically affect expression of the soluble form. Alternatively, SNP rs6269 can be a genetic marker that differentiates COMT haplotypes coding for high-activity enzyme variants from low-activity variants, consistent with other studies that found an association with rs6269 SNP in general neurological 7,52 and pain-specific 44 phenotypes. Single-nucleotide polymorphism rs6269 “G” allele is indicative of lower pain sensitivity in the established COMT 4-SNP pain sensitivity diplotypes.…”

Section: Discussionsupporting

confidence: 85%

Biopsychosocial influence on shoulder pain

George¹,

Wallace²,

Wu³

et al. 2015

Pain

View full text Add to dashboard Cite

Tailored treatment based on individual risk factors is an area with promise to improve options for pain relief. Musculoskeletal pain has a biopsychosocial nature, and multiple factors should be considered when determining risk for chronic pain. This study investigated whether subgroups comprised genetic and psychological factors predicted outcomes in preclinical and clinical models of shoulder pain. Classification and regression tree analysis was performed for an exercise-induced shoulder injury cohort (n = 190) to identify high-risk subgroups, and a surgical pain cohort (n = 150) was used for risk validation. Questionnaires for fear of pain and pain catastrophizing were administered before injury and preoperatively. DNA collected from saliva was genotyped for a priori selected genes involved with pain modulation (COMT and AVPR1A) and inflammation (IL1B and TNF/LTA). Recovery was operationalized as a brief pain inventory rating of 0/10 for current pain intensity and <2/10 for worst pain intensity. Follow-up for the preclinical cohort was in daily increments, whereas follow-up for the clinical cohort was at 3, 6, and 12 months postoperatively. Risk subgroups comprised the COMT high pain sensitivity variant and either pain catastrophizing or fear of pain were predictive of heightened shoulder pain responses in the preclinical model. Further analysis in the clinical model identified the COMT high pain sensitivity variant and pain catastrophizing subgroup as the better predictor. Future studies will determine whether these findings can be replicated in other anatomical regions and whether personalized medicine strategies can be developed for this risk subgroup.

show abstract

Section: Discussionsupporting

confidence: 85%

Biopsychosocial influence on shoulder pain

George¹,

Wallace²,

Wu³

et al. 2015

Pain

View full text Add to dashboard Cite

show abstract

“…However, the groups that followed up and those that were lost to follow-up were balanced for baseline measures. We also did not evaluate certain other factors (like presurgery sleep duration, patient perception of self-image and genetics (Buchheit et al, 2012; Sadhasivam et al, 2014) which could influence pain (Sieberg et al, 2013). Another drawback is that questionnaire data were not collected preoperatively in a small group of patients.…”

Section: Discussionmentioning

confidence: 99%

Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study

Chidambaran

Ding

Moore

et al. 2017

European Journal of Pain

101

136

View full text Add to dashboard Cite

Background Chronic postsurgical pain (CPSP) affects half a million children annually in the United States, with dire socioeconomic consequences, including long-term disability into adulthood. The few studies of CPSP in children are limited by sample size, follow-up duration, non-homogeneity of surgical procedure and factors evaluated. Methods In a prospective study of 144 adolescents undergoing a single major surgery (spine fusion), we evaluated demographic, perioperative, surgical and psychosocial factors as predictors of a continuum of postsurgical pain: immediate, pain maintenance at 2–3 months (chronic pain/CP) and persistence of pain a year (persistent pain/PP) after surgery. Results We found an incidence of 37.8% and 41.8% for CP and PP. CP and acute pain were both significant predictors for developing PP (p-value <0.001 and 0.003). Preoperative pain and higher postoperative opioid requirement was significantly associated with CP (p = 0.015, p = 0.002), while Childhood Anxiety Sensitivity Index (p = 0.002) and surgical duration (p = 0.014) predicted PP. The final regression models had reasonable predictive accuracy (c-statistic of 0.73 and 0.83 for CP and PP, respectively). Anxiety scores and catastrophizing for child and parent were found to be significantly correlated (p = 0.005, p = 0.013 respectively). Pain trajectories revealed that 65% of patients who developed PP reported CP and high pain trends; however, 33% of those who developed PP could not be identified using solely pain criteria. Conclusion Persistent postsurgical pain in children is a significant problem. It can be predicted in part by combinations of psychological and clinical variables, which may provide evidence-based measures to prevent development of CPSP in the future. Significance In a homogeneous cohort of adolescents undergoing spine fusion, we report a high incidence of persistent postsurgical pain (41.8%) predicted by child anxiety, perioperative pain, and surgical duration. Our results stress timely preventive and therapeutic strategies.

show abstract

“…There are some ethnic groups, particularly patients of African descent, who have a much higher incidence of the susceptible polymorphisms . Similarly, a recent study by Sadhasivam et al identified several catechol‐O‐methyl transferase (COMT) single nucleotide pairs (SNPs) that may play a key role in pain perception . COMT is the enzyme responsible for metabolism of catecholamines; low levels can lead to increased catecholamine levels and hyperalgesia, along with upregulation of opioid receptors.…”

Section: Discussionmentioning

confidence: 99%

Otolaryngology practice patterns in pediatric tonsillectomy: The impact of the codeine boxed warning

2017

View full text Add to dashboard Cite

Objectives/Hypothesis: To determine if otolaryngologists at a single children's hospital were adherent to the boxed warning for codeine use in post-tonsillectomy patients and the implications for practice patterns.Study Design: Case series with chart review. Methods: Charts from all patients undergoing adenotonsillectomy at a single children's hospital from January 1, 2010 through December 31, 2015 were analyzed and stratified according to date (pre-or post-boxed warning) and practitioner type (academic otolaryngologists [AO] vs. nonacademic otolaryngologists [NAO]). Demographic data, surgical technique, method of removal, narcotic prescriptions (dosage and drug), and complications were recorded. Fisher exact test was used to determine the level of significance in prescription rates pre-and postwarning. SPSS version 22 was used for statistical analysis, with P < .05 indicating statistical significance.Results: There were 2,749 children undergoing adenotonsillectomy during the study period, with 1,239 AOs and 1,510 NAOs. There was a distinct downward trend in codeine prescriptions before and after the warning, with the AO group reaching zero sooner than the NAO group. There was a 5% decrease in discharge narcotic prescriptions given postwarning (P < .001), but no significant difference in postoperative emergency department visits or pain-related complications when comparing the two time periods.Conclusions: Codeine use for management of pediatric post-tonsillectomy pain was essentially zero after issuance of the boxed warning. Total narcotic use decreased significantly without increase in pain-or medication-related complications. Future research should focus on identifying markers of increased susceptibility to adverse medication events and determining the safest options for pain management.

show abstract

Genetics of Pain Perception, COMT and Postoperative Pain Management in Children

Cited by 75 publications

References 30 publications

Biopsychosocial influence on shoulder pain

Biopsychosocial influence on shoulder pain

Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study

Otolaryngology practice patterns in pediatric tonsillectomy: The impact of the codeine boxed warning

Contact Info

Product

Resources

About