Many patients report pain several months or more after having surgery and scientists are developing clues as to why. Several studies have focused on understanding the interlinking roles of genetics, anxiety and pain.
A study presented at the 2009 Annual Meeting of the American Society of Anesthesiologists demonstrated how important it is to look at multiple factors when predicting persistent pain. Researchers from William Beaumont Hospital in Michigan studied how a specific gene (COMT) which affects how patients metabolized epinephrine (released in anxiety-provoking situations) affected patients' pain outcomes. Presence of the COMT gene is associated with having low pain sensitivity and an early study of post-surgical patients for temperomandibular joint dysfunction concluded that patients with the COMT gene experienced less pain. This led them to believe the COMT gene may provide post-surgical pain protection.
Further studies, however, disputed these results. After following another group of subjects after minimally invasive shoulder surgery, researchers were surprised to discover that patients who carried the COMT gene actually showed higher levels of pain, more disability and a lower quality of life three months after surgery than other patients. They had expected the opposite to be true.
Research presented at the 2010 Annual Meeting of the American Society of Anesthesiologists offers new data that may help doctors develop customized pain management strategies for surgical patients based on their genetic predisposition (among other factors). In these current studies patients who reported high levels of anxiety before surgery also reported increased pain at three months. When matched against other patients with similar anxiety levels, the low pain sensitivity COMT patients were actually experiencing the highest pain levels.
What's anxiety's role in pain? Researchers aren't able to say for certain, but report it may be associated with a tendency for the low pain sensitivity COMT subgroup of patients to under report anxiety. They aren't talking about the normal pre-surgery jitters everyone experiences, but the type of anxiety people experience as part of their personality or possibly with a generalized anxiety disorder. Researchers admit they hadn't considered anxiety in their initial studies associated with jaw pain. They say this demonstrates the importance of developing pain strategies that address an array of factors including genetic makeup and personality traits.
How could this affect you? If you know that anxiety is just part of who you are, talk about that with your physician, surgeon and anesthesiologist. Adding anxiety reduction techniques and medications to your post surgical pain management plan may be appropriate. Anxiety won't prevent you from a full recovery. It just might slow you down a bit.
Sources
American Society of Anesthesiologists
Anxiety or Genes? New Study Adds Evidence to Search for What Causes Long-Term Pain in Patients Receiving Minor Surgeries
http://www.asahq.org/For-the-Public-and-Media/Press-Room/ASA-News-Releases/Anxiety-or-Genes.aspx
Persistent Postsurgical Pain: Is It In Your Genes?
