Is Chronic Pain Hereditary?
Chronic pain conditions like arthritis, lower back pain and migraines are extremely common in our society. The Centers for Disease Control and Prevention estimates that 40 percent of the U.S. adult population suffers from pain lasting longer than three months. It is therefore important for medical researchers as well as the general public to understand what factors are contributing to this epidemic.
Most experts point to environmental and psychosocial factors like
- Sedentary lifestyle
- Poor diet that includes high fats, sodium and sugar
- High stress
- Lack of regular exercise
- Irregular sleep patterns
- Limited meaningful social interaction
However, there is a growing body of scientific evidence that genetics may play a key role in who contracts chronic pain conditions. One study concluded that as much as half of the risk of adult chronic pain may be due to heredity. Other factors include early neurological development, social learning, parental habits and environmental stressors.
How Does Chronic Pain Differ from Acute Pain?
It is fairly easy to believe that all forms of pain are the same, but there are many differences that separate acute pain from chronic pain. Acute pain is usually sudden and related to a specific illness or injury, while chronic pain is prolonged and often difficult to assign to a specific cause. Both kinds of pain may originate due to a physiological harm, but acute pain disappears once the underlying condition is resolved, while chronic pain does not.
Chronic pain is defined as any health condition with pain symptoms that lasts 3 months or longer. This type of pain is considerably more problematic for health care providers because it is almost always unknown what is causing the symptoms. There may be a foundational health issue that is causing the pain, but it may be difficult to diagnose, or modern medicine may have a limited understanding of the condition.
There are usually some physical and emotional effects of long-term pain that make it even more difficult to treat. In addition to physiological effects like elevated immune response and muscle tension, most chronic pain patients also suffer from anxiety and depression. Many of the mental health components of chronic pain must be treated simultaneously because they intensify pain symptoms.
Pain Conditions that Likely Have a Genetic Component
Medical researchers in the U.K. examined the medical histories of 8,000 sets of twins to find pain ailments common to both siblings. The study found that several pain conditions including pelvic pain, dry eye disease, irritable bowel syndrome and musculoskeletal pain were likely to be genetic. The study researchers concluded that although environmental factors played a role, hereditary factors could account for almost two-thirds of the chances that a chronic pain condition could develop.
Another study examined the medical history of more than 2 million patients in Utah. After identifying more than 1,200 patients with herniated or degenerated spinal discs, researchers looked into the case histories of close family members. They found that close relatives had a four times higher risk of also developing lower back pain, while even second- or third-degree relatives had a moderately higher risk of spinal disc degeneration.
In addition to a genetic component for specific chronic pain conditions, heredity may also play an important role in the intensity of pain symptoms. A new study involving more than 2,700 patients with chronic pain suggests that pain tolerance may be related to certain genes. The study classified patients as low, moderate or high pain perception and then analyzed their genes.
The genetic analysis revealed that the gene DRD1 was 33 percent more common in low pain members than high pain members. Moderate pain patients had a 25 percent higher chance of having the gene COMT and a 19 percent higher chance of having the OPRK gene. It isn’t yet understood how these genes influence pain interpretation, but this is a starting point for future research.
How Genetics Can Impact Pain Therapy
It is becoming more apparent that certain pain conditions are greatly influenced by genes. Some experts estimate that as much as 60 percent of chronic pain risk may be related to heredity. However, just because a family member has chronic pain doesn’t guarantee that you will develop a similar condition. Environmental factors like diet, sleep habits, injury and stress can be critical factors governing your health.
If you develop a chronic pain condition, your genes may also play an important role in your treatment. Medical authorities have long known that patients respond to the same therapy in various ways, but recent advances in genetic research have revealed some of the mechanisms involved.
One of the ways that patients differ is the rate at which they metabolize medications. Slow metabolizers respond better to drugs, while fast metabolizers often become resistant to medications more quickly because they break down the drugs before they reach their target. This rate of metabolism is related to genetic predisposition.
A new field called pharmacogenomics is emerging that should help tailor medication therapies to individual patients. Pharmacogenomics analyzes the DNA of patients to identify key genetic markers that may play a role in medication responses.
Although the field of pharmacogenomics is still quite young, it holds enormous promise for pain patients. For example, if markers for drug dependency can be identified, then doctors could modify an opioid regimen to reflect these risks and better optimize pain management. This information could be combined with genetic identifiers for low or high pain tolerance to produce a more granular pain profile of individual patients.
It should, however, be noted that pharmacogenomics is still in its infancy. More medical services companies are promoting their ability to leverage patient genetic data to produce more effective therapies, but, in general, it is unlikely that most of these promises are reliable. Although there have been some successes in the field and new advances are coming on line all of the time, you should ask your physician first before enlisting the help of a pharmacogenomics service. Your doctor should be able to tell you the current state of the field as well as the risks involved.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees. The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship. Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information.