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A gene controlling who feels more pain??

Posted by Sharon W on 2/21/03 at 13:12 (110176)

Were you BORN to be either a 'stoic' or a 'wimp'?

Check this out:

http://story.news.yahoo.com/news?tmpl=story2&u=/ap/20030221/ap_on_he_me/stoics_wimps&e=5

The article was written by LAURAN NEERGAARD, AP Medical Writer, and was published in Yahoo News.

I was particularly interested in this paragraph:
'Why would a gene that regulates dopamine also affect painkilling endorphins? Too much dopamine in the brain reduces endorphin content, Zubieta explained. People with the double-val gene make a very potent COMT enzyme that clears out dopamine rapidly, triggering more endorphin production, while people with the double-met gene have the opposite reaction.'

Who knows, someday perhaps genetic testing will be able to detect this at an early age and doctors will know to give drugs that regulate dopamine to control the pain of anyone who has the 'wimp' genetic code!

Sharon

Re: A gene controlling who feels more pain??

Bev N on 2/21/03 at 14:03 (110182)

I got the 'wimp' gene :( Bev

Re: A gene controlling who feels more pain??

BrianG on 2/21/03 at 16:48 (110212)

I've been following this theory for a number of years now. In fact I mentioned it to my doctor at least 10 years ago, before I even developed chronic pain. I'm glad to see these studies, as someday they may help in the way that pain is treated. It's hard enough when doctors think it's all in your head, but trying to convince them that some people experience pain worse than others, has been next to impossible. Hopefully these studies will continue, it can only help!

BrianG

Re: A gene controlling who feels more pain??

Sharon W on 2/21/03 at 17:04 (110215)

Brian,

I'm hoping that being able to do genetic testing to PROVE whether someone is genetically more sensitive to pain may someday help to keep so many suffering people from being labeled, 'just another hypochondriac,' -- at least by their own DOCTORS!

Sharon

Re: A gene controlling who feels more pain??

Marty on 2/21/03 at 18:39 (110233)

Brain,

What chronic pains do you suffer from?

Re: A gene controlling who feels more pain??

Ed Davis, DPM on 2/21/03 at 20:06 (110248)

Sharon:
Fascinating! My guess is that pain perception is a combination or genetic and acquired factors. The mental state of patients can make a big differnce in pain perception. Individuals who are depressed tolerate pain less well. Active individuals seem to do better as they amy dwell less on pain issues.

Pain issues are complex both medically and medico-legally. One very difficult area when doing independent medical exams is coming up with accurate ratings on non-tangible diagnoses and pain perception is one of those. Wish we had a 'pain meter' to be able to objectively know what someone feels -- only the person feeling the pain and Bill Clinton ('I feel your pain') knows....
Ed

Re: Dr. Ed?

Sharon W on 2/21/03 at 20:25 (110250)

Dr. Ed,

Pain specialists have determined that by using techniques such as distraction (focusing on something else, or TENS) or meditation (breathing techniques, self-hypnosis, etc.) many people can lower their pain levels. (I use self-hypnosis for this purpose, myself.) Yet for most people, it seems that the pain threshhold cannot be raised above a certain level -- and beyond that maximum pain threshhold most of us seem to feel the pain at FULL FORCE. (I do speak from personal experience, as well as from discussions with other people).

The question I have is (and I don't if ANYONE knows the answer): do these distraction and meditation techniques alter dopamine levels in the brain, then, or do they help people by some other mechanism I'm unaware of? And if those techniques DO work by altering dopamine levels, WHY does it seem that when the pain finally 'kicks in', it kicks like a MULE?? (Logically, it would seem that the effect should be somewhat more gradual, at least...)

Sharon
.

Re: Dr. Ed?

Ed Davis, DPM on 2/21/03 at 22:07 (110261)

Sharon:

Excellent question! I don't know the answer to that one. I am just going to guess at this, hopefully an educated guess. Based on what we know about opiate receptors and pain thresholds I would speculate that such techniques work by a combination of altering dopamine levels and the ability to achieve a 'disconnect' between pain centers and that portion of the brain/cerebral cortex that interprets pain. In other words, there is some actual influence on dopamine levels. The rest of the effect is essentially an attempt to get the cognitive centers of the brain to 'ignore' the pain signals. Pain is a defense mechanism and a powerful one at that so there is a level or threshold that overwhelms this technique.
Ed

Re: A gene controlling who feels more pain??

lara t on 2/21/03 at 22:24 (110265)

Is it possible that rather than emotions having a direct effect on the experience of pain, depression affects the chemistry of the body (I thikn we know it does, but I can't remember how or if it would have any likely relationship to the mechanics behind the 'pain gene'), and like the 'pain gene' alters one tolerace at a physical level?

Re: Dr. Ed

Sharon W on 2/22/03 at 07:33 (110284)

Thanks!

I'm somewhat familiar, of course, with the gate theory of pain management and I know that some theorists have proposed that distraction and meditation somehow interfere with the transmission of pain signals either past the dorsal horns or within the brain itself. It makes sense that distraction and meditation might actually alter dopamine levels AND interfere with the transmission of pain signals, somewhere between the dorsal horns and the interperetation of those signals as 'pain' (within the brain).

I find that looking for simple, one-thing-or-the-other answers often leads to inaccuracies, or at least incomplete conclusions, and that most problems in life seem to have multiple origins (or at least to involve multiple factors)

Sharon

Re: A gene controlling who feels more pain??

Ed Davis, DPM on 2/22/03 at 11:42 (110325)

Lara:

Several ways to look at this. 1) Depression leads to alteration of chemistry, leading to decreased pain tolerance; 2) Chemical imbalance leads to depression but that same (or related) chemical imbalance causes decreased pain tolerance, 3) cognitive effect of depression lowers pain threshold.
Ed

Re: Dr. Ed

Ed Davis, DPM on 2/22/03 at 12:46 (110349)

Sharon:

Your conclusion that one should avoid the simple answers is right on the mark. Pain is complex in that there are so many steps involved, from pain receptors, neural pathways, spinal cord all the way to cognition that we are still a ways off from a comprehensive understanding of how the processes inter-relate. We can just do our best to effect as many of the individual steps along the way as possible.
Ed

Re: A gene controlling who feels more pain??

Suzanne D on 2/22/03 at 13:24 (110356)

This was interesting to read, Sharon. Thanks for sharing it with us.

I can remember in years past washing dishes and having others who came along to put a plate in the water comment on how they didn't see how I could stand such hot water.

Then when my first child was born, my husband kept saying, 'This isn't as bad as I thought it would be!' (Now, how did HE know?!) :-) And the doctor made the statement afterwards that he thought I had a high tolerance for pain.

I later learned that my two children handled pain quite differently. The older one always 'made a big deal' out of every pain. I had to learn to minimize, to an extent, her complaints. My other child would hardly complain. A classic example was when she was about 3 and told me one day, 'Mommy, I hate to 'bover' you, but my ear has been hurting way down for a long time.' My first time to hear it. I took her right to the dr. who instructed me to give her the first dose of antibiotics at the drug store as he feared her ear drum was about to rupture due to such an infection.

I hope more can be learned about the complexities of how our bodies deal with pain.

Suzanne :-)

Re: A gene controlling who feels more pain??

BrianG on 2/22/03 at 20:52 (110426)

My worst pain is chronic bilateral PF, about 9-10-years now! You can also add depression, anxiety, etc.

BrianG

Re: A gene controlling who feels more pain??

Mar on 2/23/03 at 20:18 (110548)

I just read this post and article -- very interesting indeed. Another thing to think about is how different people react to different kinds of pain. An example is dental work -- some can easily tolerate an injection of novacaine and others will much prefer the pain of the drilling. Mar

Re: A gene controlling who feels more pain??

Sharon W on 2/23/03 at 21:12 (110555)

...And some are TERRIFIED of injections, any kind of injections -- while for most of us they are not that big a deal. I think fear has a lot to do it -- if you're afraid of it, whatever it is, it will hurt a LOT more.

Sharon

Re: A gene controlling who feels more pain??

Ed Davis, DPM on 2/23/03 at 21:24 (110564)

Mar and Sharon:

You have brought up another important issue -- the 'character' of pain as opposed to just the intensity of pain. Many would have more diffficlty with toleration of a sharp, nerve type pain than a more intense but duller, diffuse type of pain.
Ed

Re: Fear of pain and learned helplessness

Sharon W on 2/24/03 at 07:52 (110574)

Dr. Ed,

I know that was definitely true for me. And predictability of pain is important too. Before my TTS surgery I had a big problem with sharp, shooting pains, which were intermittent and unpredictable. Reminded me of that poor rat in Rat Lab -- it was a 'learned helplessness' experiment. Zap the rat intermittently and unpredicatability, and watch what that does to his ability to function. Pretty soon he started to forget how to run the maze, had less energy, etc. Obviously a response to having no way to predict or control the pain.

It really helped when I finally got some 'breakthrough pain' meds --Ultram. I actually only took about 8 of them, total, but it sure made a BIG difference to know that I had something that would lower my pain level once it got really high and 'take the edge off' those intermittent sharp pains I hated so much. (I could tolerate a lot more pain, once I knew I was no longer powerless to stop it!)

Sharon

Re: Fear of pain and learned helplessness

Mar on 2/24/03 at 16:53 (110632)

Yes - unpredictability and fear play a big role I think. When the pain level is a bit decreased, I find myself enjoying it but also almost paralyzed with the fear of when it is going to return. I am trying to work with the pain and stop fearing it because I know that when I fear it, i am giving it more control over me -- tough stuff! Mar

Re: Fear of pain and learned helplessness

Sharon W on 2/24/03 at 21:22 (110645)

That's much more easily said, than done. I think some of the meditation/relaxation techniques are probably the best for combatting fear, in fact that may be one of the primary ways that they are so helpful in combatting pain. But having once experienced that kind of pain and never knowing when it might return is truly TERRIFYING -- as only someone else who has 'been there' can fully understand.

Sharon

Re: Fear of pain and learned helplessness

Mar on 2/25/03 at 05:21 (110666)

Yes, the meditation and biofeedback help with the fear somewhat. They help me to focus on the moment and also to 'go somewhere else' for a little while! I think living in the moment is key to reducing fear and anxiety. The struggle is to achieve that in this crazy futuristic world we live in. Mar

Re: Fear of pain and learned helplessness

Sharon W on 2/25/03 at 07:40 (110669)

Where are you doing the biofeedback? I think that's pretty cool!

Sharon

Re: Fear of pain and learned helplessness

Mar on 2/25/03 at 09:59 (110685)

I go to the Pain Management Center at my local hospital. It really is helpful for relaxing and escaping. The theory is that when you can relax and warm the muscles, there is less pain because tight muscles increase pain. Also, the relaxing and visualization releases endorphins which reduce pain. This morning was the first time that I noticed a reduction in pain after doing it, so I guess I am getting better at it! I always feel relaxed after doing it, so even without the pain reduction, it is worth it. Mar

Re: Fear of pain and learned helplessness

Sharon W on 2/25/03 at 10:32 (110689)

It sounds wonderful. :)

Sharon

Re: Fear of pain and learned helplessness

Ed Davis, DPM on 2/26/03 at 15:59 (110891)

Sharon:
The interesting thing about Ultram is that it seems to have a niche in nerve type pain as opposed to bone and joint pain.
Ed

Re: Fear of pain and learned helplessness

Sharon W on 2/26/03 at 16:18 (110899)

Dr. Ed,

I've come across that info before -- that Ultram is especially good for nerve pain. Do you know WHY? (I suffer from insatiable curiosity...)

The Ultram did seem to work pretty well for me, brought the pain level from about 8 or 9 (where there was no way I could function at all anymore) to about 5 (where I was still in pain but could at least do the things I absolutely had to do).

Sharon

Re: Fear of pain and learned helplessness

Ed Davis, DPM on 2/26/03 at 21:27 (110935)

Sharon:
I don't know why Ultram seems to work for nerve pain. It does have some action on opiate receptors and is thus narcotic-like but not a scheduled substance.
I have a number of patients with painful diabetic neuropathy who get more relief by combining ultram and neurontin than anything else. Our local Blue Shield refuses to pay for Ultram and I have had some major arguments with them over that.
Ed

Re: Fear of pain and learned helplessness

Sharon W on 2/27/03 at 08:23 (110965)

Thanks, Dr. Ed, for being so patient with my questions.

Neurontin was the medication that made the most difference with my TTS; I really regret having waited so long to start taking it. (As I mentioned, I actually took very little Ultram -- for me the important thing about Ultram was knowing I HAD it, and that it could dull the worst of those shooting pains when I reached the point where I couldn't take it anymore.)

Sharon

Re: Fear of pain and learned helplessness

Kathy G on 2/28/03 at 10:10 (111155)

Sharon,

If cost is a factor, and as Dr. Ed said, some Blue Shield programs don't cover Ultram, remind your doctor that Ultram is now available generically. It can be a little tougher on the stomach so one has to be careful to take it with food, but it seems as effective, for most people, as the brand name.

Re: Fear of pain and learned helplessness

Ed Davis, DPM on 2/28/03 at 12:25 (111177)

Kathy:
The new generic Ultram is very reasonably priced. Teva pharmaceuticals, I believe is the first one making it.
Ed

Re: Fear of pain and learned helplessness

Ed Davis, DPM on 2/28/03 at 12:27 (111178)

Sharon:

The one potential side effect of Ultram is that it causes seizures in a small percentage of the population. Neurontin, is by design, an anti-seizure medication, so combining the two takes away the most serious potential side effect of Ultram. For some reason, combining the two seems to significanlty enhance the action of each -- synergy.
Ed

Re: Shop around for generics

Ed Davis, DPM on 2/28/03 at 12:30 (111179)

If one is paying out of pocket, it pays to shop around. Call up pharmacies. You may be surprised at the difference in prices. Also, don't assume the big chains are cheaper. Many of the big chains such as Rite Aide subsist heavily on insurance payments and have, what I consider to be, fairly high cash prices. Many of the 'mom and po' pharmacies in my area have lower prices.
Ed

Re: Ultram

Sharon W on 2/28/03 at 13:24 (111180)

Dr. Ed,

Ultram didn't cause seizures for me -- nothing like that -- but when I first took it I hadn't started Neurontin yet, and it made me feel, stressed-out, super-alert, and a bit agitated. (I definitely couldn't take it when I wanted to sleep!)

Later, on the couple of occasions when I took Ultram together with Neurontin, it didn't seem to have that side effect.

In any case, my TTS surgery was successful and I don't feel like I need Ultram now. I do still take Neurontin but that's for another problem (PN).

These questions about Ultram are just a product of my overactive curiosity...

Sharon

Re: Ultram

john h on 3/03/03 at 10:38 (111580)

I have been taking Utram for about 2 years.(50 mg) once a day or as needed. Pain specialist recommended up to 4 times a day but I generally do not take more than one and will occasionaly skip a week or more. It is not a narcotic but this drug can be sold on the street. For what reason I do not know as I have never felt any side effect such as highs,lows, sleepiness,etc. Works for some people but is just to control moderate pain and has no curative value other than reducing pain.

Re: Shop around for generics

john h on 3/03/03 at 10:40 (111581)

You are right Dr. Ed you never know where the drug will be the least expensive. Wallmart is generally low on some drugs but not always. I would also suggest checking http://www.drugstore.com they are probably the largest online drugstore and very reputable.

Re: Fear of pain and learned helplessness

john h on 3/03/03 at 10:59 (111585)

Kathy: There was never a warning to take Ultram with food on the container or that it could be a problem on the stomach. I re-read the instructions on line and there was no mention of it causing stomach problems or even taking it with food. The generaic name for Ultram is Tramadol and at drugstore.com it cost $17.99 for 30 tablets (50 mg) or $56.99 for 100 tablets. This is about half the cost of the name brand.

Re: Ultram

Sharon W on 3/03/03 at 14:20 (111612)

John h,

The thing is, you are taking Ultram for pain -- and like other pain meds, the drug will act to control pain FIRST, but if there is no pain to control and it's taken in larger amounts than it should be, Ultram supposedly can be used to get high.

I have never taken pain meds in larger quantities than prescribed, or when I was not in pain. I wouldn't want to do so because I don't LIKE the way they make me feel, kind of 'fuzzy' at times. I think that kind of 'high' must be an acquired taste, like the taste of beer or coffee or cigarettes.

Sharon

Re: Ultram

john h on 3/03/03 at 17:18 (111642)

I asked my doctor why Ultram had street value since it is not in the same calssification as Zanax or Valium. He said if you took enouhg of it like 8 or so tablets you might feel some effect. I could say that about apple cider. People looking for drug effects will try anything and put a value on most anything such as sniffing glue.

Re: Ultram

Sharon W on 3/03/03 at 17:25 (111643)

That's true. But I have never been given a painkiller that I thought would be 'fun' to take, if I were not in pain. I'd rather have a good dark beer, any day! :*)

Sharon

Re: Ultram

Mar on 3/03/03 at 19:46 (111666)

Just researched ultram and realized that it is the same as ultracet which I tried - made me sick as a dog - darn - thought there was new hope! Oh well - we keep searching! Mar