American Pain Society's 27th Annual Scientific Meeting (May 8 – 10, 2008): Catechol O-Methyltransferase (COMT) met/met genotype influences cortisol response and pain symptoms after minor motor vehicle collision (MVC)
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8125 Catechol O-Methyltransferase (COMT) met/met genotype influences cortisol response and pain symptoms after minor motor vehicle collision (MVC)

May 9, 2008: May 9, 2008
East Hall (Tampa Convention Center)
Samuel A. McLean, MD, MPH , Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
Luda Diatchenko, MD, PhD , UNC School of Dentistry, Center for Neurosensory Disorders, Chapel Hill, NC
Caroline Reed , Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
Christopher Jones, MD , Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
Erin Zaleski, MA , Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
Yogesh Mistry, MD , Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
Robert Swor, MD , Emergency Administration - 100 RO, William Beaumont Hospital, Royal Oak, MI
Mark Sochor, MD , Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
Israel Liberzon, MD, PhD , Psychiatry, University of Michigan, Ann Arbor, MI
Daniel J. Clauw, MD , Internal Medicine, University of Michigan, Ann Arbor, MI
William Maixner, DDS, PhD , UNC School of Dentistry, Center for Neurosensory Disorders, Chapel Hill, NC
Catechol O-Methyltransferase (COMT) is an enzyme which degrades catecholamines, including epinephrine, norepinephrine, and dopamine. A common functional polymorphism of the COMT gene (Val 158Met) decreases COMT thermostability, resulting in a 3-4 fold reduction in COMT enzyme activity. The allelic affects are codominant, so that individuals with the met/met genotype have the least COMT enzyme activity. In animal models, it has previously been shown that heightened catecholamine levels increase pain sensitivity. In addition, it was recently reported that individuals with the COMT met/met genotype exhibit a lower cortisol response to the Trier Social Stress Test. We assessed the association between met/met genotype and cortisol response and pain symptoms after minor MVC. 47 adult Caucasians presenting to the emergency department (ED) for care after minor MVC were recruited. ED evaluation included serial ED cortisol assessment, blood collection for subsequent DNA analysis, and an assessment of neck pain symptom severity (0-10 NRS). Dissociative symptoms were also assessed (Michigan Critical Events Perception Scale). Genotyping was performed using the Sequenom Platform. Associations between COMT met/met genotype and cortisol response and pain symptoms were assessed via repeated measures analysis and t-test, respectively. Individuals with COMT met/met genotype had a reduced ED cortisol response (AUC .106 vs. 467, p = .05) and increased pain symptoms in the ED (6.9 vs. 3.0, p = .002) vs. other genotypes. Individuals with the met/met genotype also had more dissociative symptoms (16.1 vs. 11.4, p .002). In contrast, injury Severity Score, highest Abbreviated Injury Severity score, airbag deployment, and police officer rating of crash severity at the scene were poor predictors of pain outcomes. These data provide the first report of a link between genes influencing the stress response and the physiologic and symptom response to a traumatic event.

Support: UM Chronic Pain and Fatigue Research Center; TRYUMPH Research Program; NIHK23KAR050410A.

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