title: Biopsychosocial Influence on Shoulder Pain: Influence of Genetic and Psychological Combinations on Twelve-Month Postoperative Pain and Disability Outcomes.
abstract: To identify novel combinations of genetic and psychological factors that predicted 12-month postoperative pain and disability outcomes following arthroscopic shoulder surgery.
  
  
  
  A prospective presurgical cohort (n = 150) was recruited to complete validated psychological questionnaires and have their DNA collected from saliva. DNA was genotyped for a priori selected genes involved with pain modulation (ADRB2, OPRM1, AVPR1A, GCH1, and KCNS1) and inflammation (IL1B, TNF/LTA, and IL6). The outcome measures of interest were the Brief Pain Inventory and Disabilities of the Arm, Shoulder, and Hand questionnaire. Followup for the cohort was at 3, 6, and 12 months postoperatively. After controlling for age, sex, race, and preoperative status, genetic and psychological factors were entered as main effects and interaction terms in separate general linear models for predicting postoperative pain and disability outcomes.
  
  
  
  Seven interactions involving pain-modulatory genes were identified. Three provided strong statistical evidence for different outcomes, including KCNS1 and kinesiophobia for preoperative pain intensity, ADRB2 and depressive symptoms for postoperative course, and GCH1 and anxiety symptoms for 12-month pain-intensity outcome. Ten interactions involving inflammatory genes were identified. Three provided strong statistical evidence for the 12-month postoperative course outcome, including 2 different IL6 single-nucleotide polymorphism and pain catastrophizing, and IL6 and depressive symptoms.
  
  
  
  The current study identified novel genetic and psychological interactions that can be used in future studies to further understand the development of persistent postoperative pain and investigate the effectiveness of tailored treatment.
authors.affiliation: University of Florida, Gainesville. szgeorge@phhp.ufl.edu.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.affiliation: University of Florida, Gainesville.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.affiliation: University of Florida Genetics Institute, University of Florida, Gainesville.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Wallace
authors.affiliation: University of Florida, Gainesville.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Moser
authors.affiliation: University of Florida, Gainesville.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wright
authors.affiliation: University of Florida, Gainesville.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Farmer
authors.affiliation: University of Florida, Gainesville.
authors.forename: Warren H
authors.initials: WH
authors.lastname: Greenfield
authors.affiliation: University of Florida, Gainesville.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.affiliation: University of Florida Genetics Institute, University of Florida, Gainesville.
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.affiliation: University of Florida, Gainesville.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000235:genetics / Q000523:psychology; D001182:Arthroscopy / Q000009:adverse effects*; D058443:Catastrophization / Q000235:genetics / Q000523:psychology; D003863:Depression / Q000235:genetics / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006136:GTP Cyclohydrolase / Q000032:analysis; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000235:genetics* / Q000503:physiopathology / Q000523:psychology*; D020641:Polymorphism, Single Nucleotide; D024642:Potassium Channels, Voltage-Gated / Q000032:analysis; D011446:Prospective Studies; D018343:Receptors, Adrenergic, beta-2 / Q000032:analysis; D012782:Shoulder / Q000601:surgery; D020069:Shoulder Pain / Q000235:genetics* / Q000503:physiopathology / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C553443:ADRB2 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; C503456:KCNS1 protein, human; D024642:Potassium Channels, Voltage-Gated; D018343:Receptors, Adrenergic, beta-2; D006136:GTP Cyclohydrolase