RESUMO
Chronic musculoskeletal pain affects all aspects of human life. However, mechanisms of its genetic control remain poorly understood. Genetic studies of pain are complicated by the high complexity and heterogeneity of pain phenotypes. Here, we apply principal component analysis to reduce phenotype heterogeneity of chronic musculoskeletal pain at four locations: the back, neck/shoulder, hip, and knee. Using matrices of genetic covariances, we constructed four genetically independent phenotypes (GIPs) with the leading GIP (GIP1) explaining 78.4% of the genetic variance of the analyzed conditions, and GIP2-4 explain progressively less. We identified and replicated five GIP1-associated loci and one GIP2-associated locus and prioritized the most likely causal genes. For GIP1, we showed enrichment with multiple nervous system-related terms and genetic correlations with anthropometric, sociodemographic, psychiatric/personality traits and osteoarthritis. We suggest that GIP1 represents a biopsychological component of chronic musculoskeletal pain, related to physiological and psychological aspects and reflecting pain perception and processing.
Assuntos
Dor Crônica/genética , Doenças Musculoesqueléticas/genética , Adulto , Idoso , Artralgia/genética , Dor nas Costas/genética , Feminino , Estudos de Associação Genética , Loci Gênicos/genética , Pleiotropia Genética/genética , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/genética , Fenótipo , Polimorfismo de Nucleotídeo Único , Análise de Componente Principal , Locos de Características Quantitativas/genética , Dor de Ombro/genéticaAssuntos
Corticosteroides/administração & dosagem , Bases de Dados como Assunto/estatística & dados numéricos , Dor Lombar/tratamento farmacológico , Metanálise como Assunto , Doença Crônica/tratamento farmacológico , Medicina Baseada em Evidências/normas , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/normas , Injeções Epidurais/estatística & dados numéricos , Dor Lombar/complicações , Dor Lombar/fisiopatologia , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Reprodutibilidade dos Testes , Viés de SeleçãoRESUMO
Pulsed radiofrequency treatment has been described as a minimal invasive alternative to radiofrequency thermocoagulation for the management of chronic pain syndromes. We present here our first five high-risk patients with idiopathic trigeminal neuralgia who were treated with pulsed radiofrequency after multidisciplinary assessment; with a mean follow-up of 19.2 months (range 10-26). These patients were at high risk due to age, co-morbidities or previous interventional and surgical treatments. An excellent long-term effect was achieved in three of the five patients, a partial effect in one patient and a short-term effect in one patient. No neurological side effects or complications were reported.