Departments of Anaesthesia and Intensive Care Medicine, University College Cork, Ireland.
Clin J Pain. 2011 Feb;27(2):93-101. doi: 10.1097/AJP.0b013e3181f15885.
single nucleotide polymorphisms (SNPs) in the genes for catecholamine-O-methyltransferase (COMT), μ-opioid receptor and GTP cyclohydrolase (GCH1) have been linked to acute and chronic pain states. COMT polymorphisms are associated with experimental pain sensitivity and a chronic pain state. No such association has been identified perioperatively. We carried out a prospective observational clinical trial to examine associations between these parameters and the development of postoperative pain in patients undergoing third molar (M3) extraction.
psychologic and clinical parameters were measured prospectively in a single homogeneous cohort of 100 patients undergoing M3 extraction. We genotyped the patients for SNPs within GCH1, COMT, and μ-opioid receptor 1. Primary outcome was the occurrence of pain, 3 months after surgery. Other outcomes included pain measures in the early postoperative period and the week after surgery.
seven patients (7/98; 7.1%) had persistent pain. Patients with and without persistent pain were similar in terms of perioperative demographic, psychological, and clinical parameters. The proportion who reported adequate postoperative analgesia was greater amongst those with the GG genotype for either rs4818 or rs6269 than those without (P<0.0001). The rare forms of COMT SNPs rs4818 and rs6269 were associated with postoperative pain of lesser intensity at rest (P=0.02, 0.03 respectively) and on movement (P=0.02, 0.01, respectively). The number of days until analgesia was not required during the first postoperative week was associated with GCH1 SNPs (rs8007267, P=0.05; rs3783641, P=0.01; rs10483636, P=0.002).
we report an early demonstration of a COMT SNP association with a clinically meaningful pain outcome after elective surgery.
儿茶酚氧位甲基转移酶（COMT）、μ-阿片受体和鸟苷三磷酸环化水解酶（GCH1）基因中的单核苷酸多态性（SNPs）与急性和慢性疼痛状态有关。COMT 多态性与实验性疼痛敏感性和慢性疼痛状态有关。但在围手术期尚未确定这种相关性。我们进行了一项前瞻性观察性临床试验，以研究这些参数与接受第三磨牙（M3）拔除的患者术后疼痛发展之间的关系。
前瞻性地测量了 100 例接受 M3 拔除的同质患者的心理和临床参数。我们对 GCH1、COMT 和 μ-阿片受体 1 内的 SNPs 对患者进行基因分型。主要结局是术后 3 个月时疼痛的发生。其他结局包括术后早期和术后一周的疼痛测量。
7 例（7/98；7.1%）患者存在持续性疼痛。有和没有持续性疼痛的患者在围手术期人口统计学、心理和临床参数方面相似。报告术后镇痛充分的患者中，rs4818 或 rs6269 的 GG 基因型比例大于无 GG 基因型者（P<0.0001）。COMT SNPs rs4818 和 rs6269 的罕见形式与休息时（P=0.02，0.03）和运动时（P=0.02，0.01）的术后疼痛强度较轻有关。第一周不需要镇痛的天数与 GCH1 SNPs 相关（rs8007267，P=0.05；rs3783641，P=0.01；rs10483636，P=0.002）。
我们报告了一项早期的 COMT SNP 与择期手术后临床有意义的疼痛结局相关的研究。
