Parental history of chronic pain may be associated with impairments in endogenous opioid analgesic systems.
A family history of chronic pain has previously been linked to increased incidence of spontaneous acute pain and risk for chronic pain. Mechanisms underlying these associations are unknown, although similar effects on both acute and chronic pain suggest that central endogenous analgesic system differences may be relevant. This study tested whether a positive parental chronic pain history (PH+) was associated with impaired endogenous opioid analgesic responses to acute pain. Seventy-three chronic low back pain patients (LBP) and 46 pain-free controls received opioid blockade (8mg naloxone i.v.) and placebo blockade (saline) in randomized, counterbalanced order in separate sessions. During each, subjects participated in a 1-min finger pressure pain task followed by an ischemic forearm pain task, providing pain intensity ratings during and immediately following each task. To assess opioid analgesic function, blockade effects were derived by subtracting placebo from blockade condition pain responses. Placebo condition analyses indicated that both PH+ subjects and LBP subjects reported greater acute pain sensitivity than respective comparison groups (p's<.05). Multivariate analyses indicated that, beyond any influence of current chronic pain status, PH+ subjects failed to exhibit any endogenous opioid analgesia to acute ischemic pain, whereas PH- subjects elicited effective opioid analgesia (p<.05). A significant multivariate PHxSubject Type interaction (p<.05) indicated that opioid analgesic impairments were most prominent in PH+ LBP subjects. Similar analyses for finger pressure pain blockade effects were nonsignificant (p>.10). The possible heritability of endogenous opioid analgesic dysfunction observed in individuals with a positive parental chronic pain history remains to be investigated.
Bruehl
Stephen
S
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
Chung
Ok Yung
OY
D000328:Adult; D000698:Analgesia; D001923:Brain Chemistry / Q000235:genetics / Q000502:physiology*; D002908:Chronic Disease; D018592:Cross-Over Studies; D005192:Family Health; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000235:genetics / Q000503:physiopathology*; D008297:Male; D008487:Medical History Taking; D009270:Naloxone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage; D018847:Opioid Peptides / Q000037:antagonists & inhibitors / Q000235:genetics / Q000502:physiology*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects / Q000502:physiology*; D010290:Parents; D010919:Placebos
D009292:Narcotic Antagonists; D018847:Opioid Peptides; D010919:Placebos; D009270:Naloxone