Rs11726196 Single-Nucleotide Polymorphism of the Transient Receptor Potential Canonical 3 (TRPC3) Gene Is Associated with Chronic Pain.

Chronic pain is reportedly associated with the transient receptor potential canonical 3 (TRPC3) gene. The present study examined the genetic associations between the single-nucleotide polymorphisms (SNPs) of the TRPC3 gene and chronic pain. The genomic samples from 194 patients underwent linkage disequilibrium (LD) analyses of 29 SNPs within and around the vicinity of the TRPC3 gene. We examined the associations between the SNPs and the susceptibility to chronic pain by comparing the genotype distribution of 194 patients with 282 control subjects. All SNP genotype data were extracted from our previous whole-genome genotyping results. Twenty-nine SNPs were extracted, and a total of four LD blocks with 15 tag SNPs were observed within and around the TRPC3 gene. We further analyzed the associations between these tag SNPs and chronic pain. The rs11726196 SNP genotype distribution of patients was significantly different from the control subjects even after multiple-testing correction with the number of SNPs. The TT + TG genotype of rs11726196 is often carried by chronic pain patients, suggesting a causal role for the T allele. These results contribute to our understanding of the genetic risk factors for chronic pain.

Genome-wide association study identifies candidate loci associated with chronic pain and postherpetic neuralgia.

BACKGROUND: Human twin studies and other studies have indicated that chronic pain has heritability that ranges from 30% to 70%. We aimed to identify potential genetic variants that contribute to the susceptibility to chronic pain and efficacy of administered drugs. We conducted genome-wide association studies (GWASs) using whole-genome genotyping arrays with more than 700,000 markers in 191 chronic pain patients and a subgroup of 89 patients with postherpetic neuralgia (PHN) in addition to 282 healthy control subjects in several genetic models, followed by additional gene-based and gene-set analyses of the same phenotypes. We also performed a GWAS for the efficacy of drugs for the treatment of pain. RESULTS: Although none of the single-nucleotide polymorphisms (SNPs) were found to be genome-wide significantly associated with chronic pain (p ≥ 1.858 × 10-7), the GWAS of PHN patients revealed that the rs4773840 SNP within the ABCC4 gene region was significantly associated with PHN in the trend model (nominal p = 1.638 × 10-7). In the additional gene-based analysis, one gene, PRKCQ, was significantly associated with chronic pain in the trend model (adjusted p = 0.03722). In the gene-set analysis, several gene sets were significantly associated with chronic pain and PHN. No SNPs were significantly associated with the efficacy of any of types of drugs in any of the genetic models. CONCLUSIONS: These results suggest that the PRKCQ gene and rs4773840 SNP within the ABCC4 gene region may be related to the susceptibility to chronic pain conditions and PHN, respectively.

[Physical pain in advanced cancer].

This chapter describes physical pain including pain, anorexia-cachexia syndrome, nausea-vomiting, abdominal distention, ascites, constipation and dyspnea. In effect, patients are more likely to present with several concurrent symptoms. Each of these symptoms is described separately in this chapter.

[Information and consent sheet of caudal block in the University of Tokyo Hospital].

Caudal block with a local anesthetic through the hiatus sacralis has been performed in patients with chronic low back pain, lower limb pain, anal pain, and pelvic pain due to spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, postherpetic neuralgia, peripheral vascular disease, complex regional pain syndrome and so on. We prepar- ed an information and consent sheet on caudal block in The University of Tokyo Hospital. In the information sheet, we included disease, purpose, methods, outcome, accidental complications of caudal block, other treatments, progress on unperformed case, questions and answers, influence of rejection, and doctor's name. We experienced some cases of boring pain, deterioration of low back pain and lower limb pain, headache, nausea, hypertension, hypotension, and tachycardia as accidental complications of caudal block. In describing some accidental complications, we included boring pain, high intracranial pressure, dural puncture, nerve injury, infection, hemorrhage, embolism, allergy, and heart, lung, brain, liver, and kidney failures. Further, we could refer to the accidental complications of epidural block. However, the rate of each accidental complication has not been known in detail. We should survey the outcome and accidental complication of caudal block prospectively in multiple facilities and provide the patients with useful information.

[Sinus arrest during laryngoscopy for induction of general anesthesia with intravenous fentanyl and propofol].

A 43-year-old woman with Plummer's disease underwent left thyroid lobectomy without premedication using ambulatory electrocardiogram monitoring under general anesthesia. Anesthesia was induced with an intravenous bolus of fentanyl 100 microg, lidocaine 40 mg, propofol 80 mg and vecuronium 7 mg. As she moved 5 min after induction of anesthesia, fentanyl 100 microg and propofol 30 mg were administered additionally. After positive pressure ventilation by mask for 8 min, heart rate decreased from 71 beats x min(-1) to 48 beats x min(-1), and laryngoscopy was performed. When the tip of the laryngoscope was pressed on the base of the tongue and on lifting the epiglottis, the electrocardiogram showed RR interval prolongation and gradually going to sinus arrest. The laryngoscope was removed immediately and mask ventilation was performed. The heart beat resumed at 5.5 sec after sinus arrest. Atropine 0.5 mg was given intravenously and heart rate increased to 50 beats x min(-1). Additionally atropine 0.25 mg increased heart rate to 70 beats x min(-1). The second laryngoscopy was performed uneventfully. We consider this phenomenon as a result of vagovagal reflex. Fentanyl and propofol, by reducing sympathetic tone to a greater extent than parasympathetic tone, decrease blood pressure and heart rate, and predispose to a parasympathetic response for noxious stimulation. This case indicates that intravenous injection of atropine must be immediately used for bradycardia during laryngoscopy for induction of general anesthesia with fentanyl and propofol.

[A case of thoraco-amniotic shunt for congenital cystic adenomatoid malformation].

Congenital cystic adenomatoid malformation (CCAM) is a congenital pulmonary anomaly, which may lead to fetal hydrops, pulmonary hypoplasia, and fetal or neonatal death. Recently, diagnosis and surgery for fetus have been improved. We experienced a case of CCAM, classified in Stocker class I, with a single cyst of about 5 cm in diameter. A 32 year-old pregnant woman had a fetus diagnosed as CCAM at 25 th gestational week. The thoraco-amniotic shunt placement using a modified double pig tail catheter was performed at 27 th gestational week under general anesthesia with 1% isoflurane in oxygen 2 l x min(-1) and nitrous oxide 4 l x min(-1), and 100 microg of fentanyl. Fetal movement was suppressed during surgery. This fetal therapy was effective and the cyst disappeared after surgery. The baby was delivered with caesarian section under spinal anesthesia with 0.5% bupivacaine 2.5 ml. On the next day, right lung lobectomy was accomplished under general anesthesia with fentanyl 0.2 mg and pancuronium 6.0 mg. Anesthesia with isoflurane, nitrous oxide, and fentanyl was useful for the fetal surgery of thoraco-amniotic shunt placement. Consequently, caesarian section and lung lobectomy were completed successfully.

[A case of venipuncture-induced complex regional pain syndrome].

A case of complex regional pain syndrome (CRPS) secondary to peripheral nerve injury occurring during venipuncture for post-contrast CT examination is presented. The puncture site was in the left antecubital fossa. Anatomically, cutaneous nerves lie close to cutaneous veins, making them vulnerable to injury during the procedure. This syndrome is characterized by continuing pain, allodynia, or hyperalgesia that is disproportionate to any inciting event in severity, and may lead to loss of the involved limb. The syndrome is poorly understood by radiologists and is often misdiagnosed. Early recognition and appropriate therapy are most important in treating this disorder.