Discussing the etiology of chronic pain
when there is no clear reason for chronic pain will often lead to an exploration of the Psyche. This, unfortunately, often leads to resentment on the part of those patients who have more than once heard inquiries and therapeutic suggestions which the mind interprets, and just as quickly rejects, as being "all in my head".
Fortunately or unfortunately, this can ultimately lead to a severance of the doctor-patient relationship. No one wants to be considered "crazy". Although no one necessarily believes these patients are crazy, the damage is done when assumptions are made about assumptions.
But wait; perhaps science is to the rescue once again.
A recent genetic analysis of 100 patients presenting for surgical treatment of lumbar degenerative disc disease compared to a healthy group of patients concluded there were different levels of two pain modulating genes. These genes may predispose some patients to the experience of chronic pain associated with lumbar degenerative disc disease, as not all such patients necessarily suffer chronic pain.
This study, presented at the recent North American Spine Society meeting, and similar studies, are of great importance to an understanding that the experience of pain can be determined by genetics. Continued exploration of the genetics of pain would be helpful in a variety of settings, with a variety of illnesses.
The 100 patients in the aforementioned study were adults with moderate to severe low back pain that had not responded to at least 6 months of conservative (non-surgical) treatment. Researchers focused on two genes suspected of increasing the risk of chronic pain: the catecholamine-O-methyltransferase gene (COMT) and the GTP cyclohydrolase 1 gene (GCH1).
Four single nucleotide polymorphisms in the GCH1 gene were significantly different in the degenerative disc disease population compared with the general population. Three single nucleotide polymorphisms were underrepresented, consistent with a genetic configuration that previous research has shown confers protection against the development of chronic pain.
Thus, the research findings at least support the hypothesis that the GCH1 pain-protective gene configuration may prevent the development of chronic pain following back or spinal injury. Additionally, it was found that a GCH1 version that is relatively rare in the general population was overly abundant in the degenerative disc disease patients.
So, while more study is needed, there does appear to be in certain patients a genetic predisposition to suffer chronic pain. If genetic analysis allows for fair and accurate identification of such pain sufferers, there may be new treatments available, not to mention new sensitivities developed, which improve the quality of life for those with chronic pain, and those who treat chronic pain.