Abstract Description
Institution: Uppsala University, Sweden - Uppland, Sverige
It is not known why some patients develop persistent pain after surgery (PPS) while others do not. Among multiple risk factors for the development of PPS, a neuropathic mechanism due to iatrogenic nerve lesion has been proposed as the major cause of PPS. As there is some evidence that the Human Leukocyte Antigen (HLA) system plays a role in PPS, this study aimed to identify the genetic risk factors specifically among HLA-loci associated with persistent pain after trauma and surgery of the nerve injuries in the upper extremities.
Methods
Blood samples were taken to investigate the contribution of HLA alleles (i.e. HLA-A, HLA-B, HLA-DRB1, HLA-DQB1, HLA-DPB1) in a group of subjects with persistent neuropathic pain (n=70) and a group of patients with neuropathy without pain (n=61). All subjects had intraoperatively verified nerve damage in the upper extremity. They underwent bedside clinical neurological examination to identify the neuropathic pain component according to the present grading system of neuropathic pain. Statistical analyses on the allele, haplotype were carried out using the BIGDAWG package.
Results
We found that the HLA-haplotype A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02, was associated with an increased risk of developing persistent neuropathic pain in the upper extremity (OR=9.31 [95% CI 1.28-406.45], p<0.05). No significant associations were found on an allele level when correcting for multiple testing.
Conclusion
In this study, we demonstrated that there is an association between HLA and the risk of developing persistent neuropathic pain after traumatic nerve injury and surgery. We found a significantly increased risk of developing persistent neuropathic pain among carriers of the HLA haplotype A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02. We believe this finding to be of clinical importance since it may be used to stratify for risk in situations of trauma and surgical procedures, but also that further mechanistic dissection may unravel pathways that can be targeted therapeutically.
Presenters
Authors
Authors
Increased risk of persistent neuropathic pain pain after traumatic nerve injury and surgery for carriers of the A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 haplotype Adriana Miclescu - Uppsala University Hospital , Increased risk of persistent neuropathic pain pain after traumatic nerve injury and surgery for carriers of the A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 haplotype Clara Rönngren - Mutidisciplinary Pain Clinic, Dept Surgical Sciences, Uppsala University, Sweden , Increased risk of persistent neuropathic pain pain after traumatic nerve injury and surgery for carriers of the A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 haplotype Mats Bengtsson - Dept of Immunology, Genetics and Pathology, Uppsala University, Sweden , Increased risk of persistent neuropathic pain pain after traumatic nerve injury and surgery for carriers of the A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 haplotype Anders Hedin - , Increased risk of persistent neuropathic pain pain after traumatic nerve injury and surgery for carriers of the A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 haplotype Torsten Gordh jr - Multidicsipilnary Pain Clinic, Dept Surgical Sciences, Uppsala University, Sweden
