TY - JOUR
T1 - Dopaminergic neurotransmission and genetic variation in chronification of post-surgical pain
AU - van Reij, Roel R. I.
AU - Joosten, Elbert A. J.
AU - van den Hoogen, Nynke J.
N1 - Funding Information:
Department of Anaesthesiology (Maastricht University Medical Center+ (MUMC+), the Netherlands, and School of Mental Health, and Neuroscience (MHeNS, Universiteit of Maastricht, the Netherlands).
Publisher Copyright:
© 2019 British Journal of Anaesthesia
PY - 2019/12
Y1 - 2019/12
N2 - Chronic post-surgical pain (CPSP) is a debilitating condition affecting 10-50% of surgical patients. The current treatment strategy for CPSP is not optimal, and the identification of genetic variation in surgical patients might help to improve prediction and treatment of CPSP. The neurotransmitter dopamine (DA) has been associated with several chronic pain disorders. This narrative review focuses on DA neurotransmission as a potential target in the treatment of CPSP. The current knowledge on genetic variation within DA neurotransmission and its role in CPSP susceptibility are reviewed. Three genes involved in DA neurotransmission (COMT, GCH1, and DRD2) have been associated with variability in pain sensitivity, development of CPSP, and analgesic requirement. The direction of the effect of the association is sometimes inconclusive because of contradictory results, but ample evidence suggests a modulatory role of DA. Because of this modulatory role, DA is an excellent pharmacological target in the treatment of pain. Pharmacotherapy focused on DA neurotransmission has potential in both prevention (via D1-like receptors) and treatment (via D2-like receptors and DA reuptake inhibitors) of CPSP. The development of prediction models including genetic risk factors is necessary to better identify patients at risk.
AB - Chronic post-surgical pain (CPSP) is a debilitating condition affecting 10-50% of surgical patients. The current treatment strategy for CPSP is not optimal, and the identification of genetic variation in surgical patients might help to improve prediction and treatment of CPSP. The neurotransmitter dopamine (DA) has been associated with several chronic pain disorders. This narrative review focuses on DA neurotransmission as a potential target in the treatment of CPSP. The current knowledge on genetic variation within DA neurotransmission and its role in CPSP susceptibility are reviewed. Three genes involved in DA neurotransmission (COMT, GCH1, and DRD2) have been associated with variability in pain sensitivity, development of CPSP, and analgesic requirement. The direction of the effect of the association is sometimes inconclusive because of contradictory results, but ample evidence suggests a modulatory role of DA. Because of this modulatory role, DA is an excellent pharmacological target in the treatment of pain. Pharmacotherapy focused on DA neurotransmission has potential in both prevention (via D1-like receptors) and treatment (via D2-like receptors and DA reuptake inhibitors) of CPSP. The development of prediction models including genetic risk factors is necessary to better identify patients at risk.
KW - chronic post-surgical pain
KW - dopamine
KW - pain sensitivity
KW - pharmacology
KW - single nucleotide polymorphisms
KW - CATECHOL-O-METHYLTRANSFERASE
KW - SUBSTANTIA-GELATINOSA NEURONS
KW - RESTLESS LEGS SYNDROME
KW - POSTOPERATIVE PAIN
KW - SPINAL-CORD
KW - PARKINSONS-DISEASE
KW - IN-VIVO
KW - NEUROPATHIC PAIN
KW - COMT GENE
KW - RAT MODEL
U2 - 10.1016/j.bja.2019.07.028
DO - 10.1016/j.bja.2019.07.028
M3 - (Systematic) Review article
C2 - 31558312
SN - 0007-0912
VL - 123
SP - 853
EP - 864
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 6
ER -