title: Biopsychosocial influence on shoulder pain: risk subgroups translated across preclinical and clinical prospective cohorts.
abstract: Tailored treatment based on individual risk factors is an area with promise to improve options for pain relief. Musculoskeletal pain has a biopsychosocial nature, and multiple factors should be considered when determining risk for chronic pain. This study investigated whether subgroups comprised genetic and psychological factors predicted outcomes in preclinical and clinical models of shoulder pain. Classification and regression tree analysis was performed for an exercise-induced shoulder injury cohort (n = 190) to identify high-risk subgroups, and a surgical pain cohort (n = 150) was used for risk validation. Questionnaires for fear of pain and pain catastrophizing were administered before injury and preoperatively. DNA collected from saliva was genotyped for a priori selected genes involved with pain modulation (COMT and AVPR1A) and inflammation (IL1B and TNF/LTA). Recovery was operationalized as a brief pain inventory rating of 0/10 for current pain intensity and <2/10 for worst pain intensity. Follow-up for the preclinical cohort was in daily increments, whereas follow-up for the clinical cohort was at 3, 6, and 12 months postoperatively. Risk subgroups comprised the COMT high pain sensitivity variant and either pain catastrophizing or fear of pain were predictive of heightened shoulder pain responses in the preclinical model. Further analysis in the clinical model identified the COMT high pain sensitivity variant and pain catastrophizing subgroup as the better predictor. Future studies will determine whether these findings can be replicated in other anatomical regions and whether personalized medicine strategies can be developed for this risk subgroup.
authors.affiliation: Department of Physical Therapy, University of Florida, Gainesville, FL, USA Department of Molecular Genetics and Microbiology and UF Genetics Institute, University of Florida, Gainesville, FL, USA Departments of Biostatistics Orthopaedics and Rehabilitation, and Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Wallace
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.forename: Michael W
authors.initials: MW
authors.lastname: Moser
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wright
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Farmer
authors.forename: Paul A
authors.initials: PA
authors.lastname: Borsa
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Parr
authors.forename: Warren H
authors.initials: WH
authors.lastname: Greenfield
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058443:Catastrophization / Q000175:diagnosis* / Q000523:psychology*; D015331:Cohort Studies; D005239:Fear / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D020069:Shoulder Pain / Q000175:diagnosis* / Q000523:psychology*; D055815:Young Adult