Current evidence for a modulation of low back pain by human genetic variants

Tegeder, Irmgard; Lötsch, Jörn

doi:10.1111/j.1582-4934.2009.00703.x

Cited by 59 publications

(40 citation statements)

References 205 publications

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“…Interpreting data in the context of putative mechanisms underlying somatosensory characteristics requires these considerations: numerous interacting mechanisms may generate similar clinical signs; similar sensory characteristics may exist despite divergent mechanisms 79 ; genetics and epigenetics influence CLBP intensity, nociception, and QST 64,72 ; psychosocial factors influence pain sensitivity 21,38,40 ; nociception and its association with attention are in constant flux 39 ; comparisons with other studies are complicated by a lack of normative data for our test sites 48,53,57,61 and varied protocols. 14,66 Cluster 1 was characterised by average to high pressure and thermal pain sensitivity at the lumbar region and remotely, suggesting multisensory nociceptive hypersensitivity of superficial and deep tissues (thermal sensitivity, tested using a thermode, stimulates superficial structures; pressure sensitivity is mediated by deep tissue stimulation 17,26 ).…”

Section: Discussionmentioning

confidence: 97%

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

Rabey

Slater²,

O’Sullivan³

et al. 2015

Pain

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The objectives of this study were to explore the existence of subgroups in a cohort with chronic low back pain (n = 294) based on the results of multimodal sensory testing and profile subgroups on demographic, psychological, lifestyle, and general health factors. Bedside (2-point discrimination, brush, vibration and pinprick perception, temporal summation on repeated monofilament stimulation) and laboratory (mechanical detection threshold, pressure, heat and cold pain thresholds, conditioned pain modulation) sensory testing were examined at wrist and lumbar sites. Data were entered into principal component analysis, and 5 component scores were entered into latent class analysis. Three clusters, with different sensory characteristics, were derived. Cluster 1 (31.9%) was characterised by average to high temperature and pressure pain sensitivity. Cluster 2 (52.0%) was characterised by average to high pressure pain sensitivity. Cluster 3 (16.0%) was characterised by low temperature and pressure pain sensitivity. Temporal summation occurred significantly more frequently in cluster 1. Subgroups were profiled on pain intensity, disability, depression, anxiety, stress, life events, fear avoidance, catastrophizing, perception of the low back region, comorbidities, body mass index, multiple pain sites, sleep, and activity levels. Clusters 1 and 2 had a significantly greater proportion of female participants and higher depression and sleep disturbance scores than cluster 3. The proportion of participants undertaking <300 minutes per week of moderate activity was significantly greater in cluster 1 than in clusters 2 and 3. Low back pain, therefore, does not appear to be homogeneous. Pain mechanisms relating to presentations of each subgroup were postulated. Future research may investigate prognoses and interventions tailored towards these subgroups.

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Section: Discussionmentioning

confidence: 97%

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

Rabey

Slater²,

O’Sullivan³

et al. 2015

Pain

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“…Genotyping for risk factors might be a pathway worth exploring, as it has recently been demonstrated that there is a link between musculoskeletal pain and genetic variations in the primary stress response system [63][64][65]. However, the reported associations are modest and partially explained by psychological comorbidity [64].…”

Section: Future Perspectivementioning

confidence: 94%

An overview of conservative treatment for lower back pain

Balagué¹

2011

International Journal of Clinical Rheumatology

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Low back pain (LBP) remains the most frequent musculoskeletal complaint worldwide and all age groups are affected by these symptoms. They are classically stratified into acute, subacute and chronic, with respective cut-offs of <6 weeks, 6-12 weeks and >12 weeks [1].By itself, it produces direct and indirect costs of hundreds of billions of dollars for the US alone. Recent studies in adults and elderly populations have shown a significant increase in LBP, both in numbers and costs, in terms of investigations, treatments and disability, an observation at least partially explained by a raise in prevalence [2,101]. However, the large differences in the rate of spinal surgical procedures observed between states within the US [3], as well as between countries worldwide, suggest that decision-making is certainly influenced by regulations and other sociopolitical factors.As LBP is extremely prevalent, the main problem remains the chronic cases, in particular in term of investigations and costs. Acute episodes of LBP statistically have quite a good prognosis more or less independently of the chosen treatment. A recent review confirms that a variety of treatments of acute LBP are effective and supported by the literature [4]. Moreover, there are excellent updated reviews on the management of acute pain not limited to but including LBP [5]. The interested reader can download this electronically [102].If until recently a figure of 8-10% was usually accepted as the number of acute LBP episodes evolving into chronic cases, recent studies have show much more ominous figures with frequent relapses and persistence of symptoms at 1 year in up to 10-30% of cases according to definitions used. On the other hand, more than a third of the patients with LBP for more than 3 months do recover within 12 months [6][7][8][9].Defining if a patient is going to become chronic or establishing an individual prognosis based on epidemiological studies is a very difficult task. Certainly, a precise diagnosis would help. However, it is commonly accepted that a specific identifiable etiology is only found in around 15% of cases, including disk herniations, spinal stenosis, osteoporotic fractures, inflammatory diseases and the infrequent (approximately 1%) specific neoplastic or infectious destructive lesions [10]. The largest part of this manuscript is devoted to the 85% of patients asking for medical attention and suffering from chronic LBP without any of those specific identifiable etiologies, the so-called nonspecific (NS) LBP. Furthermore, we included spinal stenosis and lumbar disc herniation in the discussion in regard to their frequency in daily practice.It has been shown already in adolescent populations that psychosocial factors are stronger predictors of incident LBP than mechanical factors [11]. In adult populations, psychosocial factors are risk factors for chronicity much more strongly related to outcome than any clinical or mechanical variables [12,13], while previous episodes of pain are strong predictors of future ones. Twin's cohort ...

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“…For other symptoms and adverse events (e.g., nausea, vomiting, constipation and tiredness), no general agreements exist as to which tool to use in studies for classification of severity and measurement of patients' subjective impairment [3]. Chronic pain, as described in the recent review on low back pain [119], is a complex symptom broadly influenced by physical, psychological, social-environmental and spiritual components [3,116,[120][121][122]. Pain history and type of diagnosis (e.g., pain owing to cancer vs postoperative pain) play a role; although, former trials mostly focused on the 'genetic reductionist approach, reducing the holistic solution to a problem to a single genetic test' [123].…”

Section: Study Designsmentioning

confidence: 99%

Personalized Therapy in Pain Management: Where Do We Stand?

Stamer¹,

Zhang

Stüber

2010

Pharmacogenomics

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Genomic variations influencing response to pharmacotherapy of pain are currently under investigation. Drug-metabolizing enzymes represent a major target of ongoing research in order to identify associations between an individual's drug response and genetic profile. Polymorphisms of the cytochrome P450 enzymes (CYP2D6) influence metabolism of codeine, tramadol, hydrocodone, oxycodone and tricyclic antidepressants. Blood concentrations of some NSAIDs depend on CYP2C9 and/or CYP2C8 activity. Genomic variants of these genes associate well with NSAIDs' side effect profile. Other candidate genes, such as those encoding (opioid) receptors, transporters and other molecules important for pharmacotherapy in pain management, are discussed; however, study results are often equivocal. Besides genetic variants, further variables, for example, age, disease, comorbidity, concomitant medication, organ function as well as patients' compliance, may have an impact on pharmacotherapy and need to be addressed when pain therapists prescribe medication. Although pharmacogenetics as a diagnostic tool has the potential to improve patient therapy, well-designed studies are needed to demonstrate superiority to conventional dosing regimes.

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Current evidence for a modulation of low back pain by human genetic variants

Abstract: Abstract

Cited by 59 publications

References 205 publications

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

An overview of conservative treatment for lower back pain

Personalized Therapy in Pain Management: Where Do We Stand?

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