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Biopsychosocial Influence on Shoulder Pain: Influence of Genetic and Psychological Combinations on Twelve‐Month Postoperative Pain and Disability Outcomes
Author(s) -
George Steven Z.,
Wu Samuel S.,
Wallace Margaret R.,
Moser Michael W.,
Wright Thomas W.,
Farmer Kevin W.,
Greenfield Warren H.,
Dai Yunfeng,
Li Hua,
Fillingim Roger B.
Publication year - 2016
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22876
Subject(s) - biopsychosocial model , pain catastrophizing , medicine , anxiety , physical therapy , cohort , chronic pain , psychiatry
Objective To identify novel combinations of genetic and psychological factors that predicted 12‐month postoperative pain and disability outcomes following arthroscopic shoulder surgery. Methods A prospective presurgical cohort (n = 150) was recruited to complete validated psychological questionnaires and have their DNA collected from saliva. DNA was genotyped for a priori selected genes involved with pain modulation ( ADRB2 , OPRM1 , AVPR1A , GCH1 , and KCNS1 ) and inflammation ( IL1B , TNF/LTA , and IL6 ). The outcome measures of interest were the Brief Pain Inventory and Disabilities of the Arm, Shoulder, and Hand questionnaire. Followup for the cohort was at 3, 6, and 12 months postoperatively. After controlling for age, sex, race, and preoperative status, genetic and psychological factors were entered as main effects and interaction terms in separate general linear models for predicting postoperative pain and disability outcomes. Results Seven interactions involving pain‐modulatory genes were identified. Three provided strong statistical evidence for different outcomes, including KCNS1 and kinesiophobia for preoperative pain intensity, ADRB2 and depressive symptoms for postoperative course, and GCH1 and anxiety symptoms for 12‐month pain‐intensity outcome. Ten interactions involving inflammatory genes were identified. Three provided strong statistical evidence for the 12‐month postoperative course outcome, including 2 different IL6 single‐nucleotide polymorphism and pain catastrophizing, and IL6 and depressive symptoms. Conclusion The current study identified novel genetic and psychological interactions that can be used in future studies to further understand the development of persistent postoperative pain and investigate the effectiveness of tailored treatment.