Chronic persistent surgical pain is strongly associated with COMT alleles in patients undergoing cardiac surgery with me
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ORIGINAL ARTICLE
Chronic persistent surgical pain is strongly associated with COMT alleles in patients undergoing cardiac surgery with median sternotomy Goduguchintha Dharaniprasad1 · Aloka Samantaray1 · Lokanathan Srikanth2 · Mangu Hanumantha Rao1 · Abha Chandra3 · Potukuchi Venktata Gurunadha Krishna Sarma2 Received: 30 December 2019 / Accepted: 16 February 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives Catechol-O-methyl transferase (COMT), a catechol-dependent enzyme, plays pivotal role in the development of pain. In different ethnic populations, it is associated with chronic persistent surgical pain (CPSP). In this context, the present study is aimed to assess involvement of COMT allele (Val158Met) in the development of CPSP. Methodology The patients (n = 216) underwent cardiac surgery with median sternotomy were selected to assess the magnitude of the CPSP evaluated with pain questionnaires’ after 3 months from surgery. The exon 4 of COMT gene was PCR amplified and sequenced. The quantitative gene expression of COMT using RT-PCR corroborated the COMT enzyme activity. Results Among 216 patients who underwent sternotomy procedure, 54 patients showed CPSP even after 3 months from surgery. The sequence analysis revealed that, in 25% (54/216) patients having following one or more alleles: c.472G>A (Val158Met) (reported), and novel c.382C>G;c.383G>C (Arg128Ala), c.373C>G (Arg125Gly), c.370G>A (Val124Met), c.359G>C (Gly120Ala), c.349G>A, c.350G>A(Ala117Ser), c.349G>C, c.351C>A (Ala117Pro), c.349G>A (Ala117Thr), c.350G>C (Ala117Gly), and c.405G>C (Ala135Ser) were observed for the first time in Indian population. Distinct CPSP (≥ 4 NRS pain score) was observed in these patients correlating with COMT enzyme activity (7.80 ± 0.92 units/mg) which is 14 times lowered when compared with non-CPSP patient’s (n = 162) 110.15 ± 6.41 units/mg. The findings of COMT gene expression using quantitative RT-PCR corroborated the COMT enzyme activity. Conclusion The dominant effect of mutant COMT alleles connecting with low enzyme activity resulted in CPSP, warrants COMT genetic analysis prior to surgery was useful to predict the occurrence of CPSP. Keywords CPSP · Polymorphism · Val158Met · Arg128Ala · COMT
Introduction Chronic persistent surgical pain caused by surgical procedures is a significant clinical problem. Intensity of acute postoperative pain is a predictor of chronic pain and often complicates the recovery process after surgery. Optimizing * Aloka Samantaray [email protected] 1
Department of Anesthesiology, SVIMS University, Tirupati, Andhra Pradesh 517507, India
2
Department of Biotechnology, SVIMS University, Tirupati, Andhra Pradesh, India
3
Department of C.T. Surgery, SVIMS University, Tirupati, Andhra Pradesh, India
pain management after surgery is thus important to enhance patient comfort and expedite recovery [1, 2]. The etiology of post-surgical pain is still poorly understood, and the mechanisms involved are multiple, including tissue injury related to the i
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