title: Biopsychosocial influence on exercise-induced injury: genetic and psychological combinations are predictive of shoulder pain phenotypes.
abstract: Chronic pain is influenced by biological, psychological, social, and cultural factors. The current study investigated potential roles for combinations of genetic and psychological factors in the development and/or maintenance of chronic musculoskeletal pain. An exercise-induced shoulder injury model was used, and a priori selected genetic (ADRB2, COMT, OPRM1, AVPR1 A, GCH1, and KCNS1) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as predictors. Pain phenotypes were shoulder pain intensity (5-day average and peak reported on numerical rating scale), upper extremity disability (5-day average and peak reported on the QuickDASH), and shoulder pain duration (in days). After controlling for age, sex, and race, the genetic and psychological predictors were entered as main effects and interaction terms in separate regression models for the different pain phenotypes. Results from the recruited cohort (N = 190) indicated strong statistical evidence for interactions between the COMT diplotype and 1) pain catastrophizing for 5-day average upper extremity disability and 2) depressive symptoms for pain duration. There was moderate statistical evidence for interactions for other shoulder pain phenotypes between additional genes (ADRB2, AVPR1 A, and KCNS1) and depressive symptoms, pain catastrophizing, or kinesiophobia. These findings confirm the importance of the combined predictive ability of COMT with psychological distress and reveal other novel combinations of genetic and psychological factors that may merit additional investigation in other pain cohorts.
  
  
  CONCLUSIONS
  Interactions between genetic and psychological factors were investigated as predictors of different exercise-induced shoulder pain phenotypes. The strongest statistical evidence was for interactions between the COMT diplotype and pain catastrophizing (for upper extremity disability) or depressive symptoms (for pain duration). Other novel genetic and psychological combinations were identified that may merit further investigation.
authors.affiliation: Department of Physical Therapy, Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida. Electronic address: szgeorge@phhp.ufl.edu.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.affiliation: Comprehensive Center for Pain Research, University of Florida, Gainesville, Florida.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Parr
authors.affiliation: Department of Molecular Genetics and Microbiology, UF Genetics Institute, Center for Epigenetics, University of Florida, Gainesville, Florida.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Wallace
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, Florida.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Borsa
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, Florida.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries; D058443:Catastrophization / Q000150:complications; D002394:Catechol O-Methyltransferase / Q000235:genetics; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D006801:Humans; D051662:Kv1.1 Potassium Channel / Q000235:genetics; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications; D010147:Pain Measurement; D010641:Phenotype; D011237:Predictive Value of Tests; D016601:RNA-Binding Proteins / Q000235:genetics; D018342:Receptors, Adrenergic, beta-1 / Q000235:genetics; D020069:Shoulder Pain / Q000209:etiology / Q000235:genetics / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: C547787:ADRB1 protein, human; C496946:KCNA1 protein, human; D016601:RNA-Binding Proteins; D018342:Receptors, Adrenergic, beta-1; D051662:Kv1.1 Potassium Channel; C588010:COMT protein, human; D002394:Catechol O-Methyltransferase
keywords: COMT; Chronic pain; muscle pain; pain candidate genes; psychological predictors; single nucleotide polymorphism