George Steven Z, Parr Jeffrey J, Wallace Margaret R, Wu Samuel S, Borsa Paul A, Dai Yunfeng, Fillingim Roger B
1Department of Physical Therapy, Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL; 2Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA; 3Department of Molecular Genetics and Microbiology, Center for Epigenetics, Genetics Institute, University of Florida, Gainesville, FL; 4Department of Biostatistics, University of Florida, Gainesville, FL; 5Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL; and 6Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL.
Med Sci Sports Exerc. 2014 Oct;46(10):1871-81. doi: 10.1249/MSS.0000000000000328.
The pain experience has multiple influences, but little is known about how specific biological and psychological factors interact to influence pain responses. The current study investigated the combined influences of genetic (pro-inflammatory) and psychological factors on several preclinical shoulder pain phenotypes.
An exercise-induced shoulder injury model was used, and a priori selected genetic (IL1B, TNF/LTA region, and IL6 single nucleotide polymorphisms (SNP)) and psychological (anxiety, depression symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as the predictors of interest. The phenotypes were pain intensity (5-d average and peak reported on numerical rating scale), upper extremity disability (5-d average and peak reported on the Quick Disabilities of the Arm, Shoulder and Hand instrument), and duration of shoulder pain (d).
After controlling for age, sex, and race, the genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each pain phenotype. Results from the recruited cohort (n = 190) indicated strong statistical evidence for the interactions between 1) TNF/LTA SNP rs2229094 and depression symptoms for average pain intensity and duration and 2) IL1B two SNP diplotype and kinesiophobia for average shoulder pain intensity. Moderate statistical evidence for prediction of additional shoulder pain phenotypes included interactions of kinesiophobia, fear of pain, or depressive symptoms with TNF/LTA rs2229094 and IL1B.
These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts to determine their involvement in the transition from acute to chronic pain conditions.
疼痛体验受多种因素影响，但对于特定生物学和心理学因素如何相互作用以影响疼痛反应，我们知之甚少。本研究调查了基因（促炎）和心理因素对几种临床前肩部疼痛表型的综合影响。
采用运动诱发的肩部损伤模型，将预先选定的基因（IL1B、TNF/LTA区域和IL6单核苷酸多态性（SNP））和心理因素（焦虑、抑郁症状、疼痛灾难化、疼痛恐惧和运动恐惧）作为感兴趣的预测因素。表型包括疼痛强度（数字评分量表上报告的5天平均值和峰值）、上肢功能障碍（手臂、肩部和手部快速功能障碍量表上报告的5天平均值和峰值）以及肩部疼痛持续时间（天）。
在控制了年龄、性别和种族后，基因和心理预测因素分别作为主效应和交互项纳入每种疼痛表型的回归模型。纳入队列（n = 190）的结果表明，有强有力的统计学证据支持以下相互作用：1）TNF/LTA SNP rs2229094与抑郁症状对平均疼痛强度和持续时间的影响；2）IL1B两个SNP双倍型与运动恐惧对平均肩部疼痛强度的影响。对于其他肩部疼痛表型预测的中等统计学证据包括运动恐惧、疼痛恐惧或抑郁症状与TNF/LTA rs2229094和IL1B的相互作用。
这些发现通过揭示可能值得在临床队列中进一步研究以确定其在从急性疼痛向慢性疼痛转变过程中所起作用的新组合，支持了特定基因和心理因素对肩部疼痛表型的综合预测能力。
