Premium
High post surgical opioid requirements in Crohn's disease are not due to a general change in pain sensitivity
Author(s) -
Huehne Kathrin,
Leis Stefan,
Muenster Tino,
Wehrfritz Andreas,
Winter Stefanie,
Maihöfner Christian,
Foertsch Thomas,
Croner Roland,
Reis André,
Winterpacht Andreas,
Rautenstrauss Bernd
Publication year - 2009
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2008.12.004
Subject(s) - opioid , medicine , disease , catechol o methyl transferase , crohn's disease , anesthesia , gene , receptor , genotype , biology , genetics
Crohn's disease (CD) is a painful inflammatory bowel disease with complex multigenic inheritance. Suggested on the basis of a few isolated reports CD patients require significantly higher post operative opioid doses than patients undergoing comparable severe abdominal surgery. Crohn's disease therefore may be a suitable model for the identification of novel pain susceptibility genes. In order to confirm this observation and to elucidate the underlying molecular mechanisms, we investigated if higher opioid needs of CD patients are due to a general change in pain sensitivity. Quantitative sensory testing (QST) was applied to a subgroup of patients and polymorphisms in the μ‐opioid receptor ( OPRM1 ) and catechol‐O‐methyltransferase ( COMT ) were investigated. Significantly increased post operative opioid requirements in CD patients were confirmed and QST assessment demonstrates that CD patients do not display increased pain sensitivity in terms of lowered thresholds to thermal and mechanical stimuli. The data also suggest that common variants in OPRM1 and specific ‘high pain sensitivity’ COMT haplotypes may not be the cause of high opioid needs. The results indicate that a more complex pathway is involved in the greater post operative opioid demand in CD. Therefore the presence of other, as yet unknown, genes could modulate opioid requirements in CD patients.