Tag Archives: genetics

Chronic pain leads to epigenetic changes

Chronic pain changes our immune systems | Channels – McGill University – By Cynthia Lee – Jan 2016

Many anti-opioid folks believe it’s always better not to prescribe/take opioids because they are so extremely dangerous, while pain is “just a feeling” that a person can “deal with”.

However, they are wrong. Pain is not just a “feeling”.

Leaving pain poorly controlled can lead to changes in how our genes are expressed, especially in the immune system.

Pain is the body’s alarm system, intended to get you moving to either fight or flee. It’s an extreme stressor which initiates a chain of biochemical consequences, including those that turn some of our genes on and off.  Continue reading

Guidelines for the Treatment of Hypothyroidism

Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement – 2014 Dec – free full-text PMC article

related to The Fibromyalgia-Thyroid Connection

Background: A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy

The purpose of this task force was to review

  • the goals of levothyroxine therapy,
  • the optimal prescription of conventional levothyroxine therapy,
  • the sources of dissatisfaction with levothyroxine therapy,
  • the evidence on treatment alternatives, and
  • the relevant knowledge gaps.

This document is intended to inform clinical decision-making on thyroid hormone replacement therapy; it is not a replacement for individualized clinical judgment.  Continue reading

Dubious gene test for addiction risk

Dubious gene test for addiction risk exploits loophole and opioid fears

Proove claims its test can predict, with 93 percent accuracy, which patients will become addicted to or misuse prescribed opioid pain pills.

That’s been an irresistible sales pitch for many physicians, who struggle to treat pain patients compassionately but fear adding to the national epidemic of opioid addiction.

The Irvine, Calif., company has recruited 400 doctors, who have used the test to guide their treatment of more than 100,000 patients in the last five years.   Continue reading

Individual variety in response to opioids

Identifying Patients With Higher Methadone Dose RequirementsHelen Fosam, PhDFeb 2017

The variation in response to pharmacological agents between individuals has been recognized for decades.

Unfortunately, the CDC and the other guideline-writing groups are deliberately ignoring this truth. The public is kept ignorant about this criminal negligence of scientific truth (evidence) in the documents created by these groups.

However, the underlying genetic basis that provides a rational explanation for the observation that different individuals can display widely different responses to the same pharmacological agent came to light with the sequencing of the human genome, which allowed the identification of thousands of gene polymorphisms, most often single nucleotide polymorphisms (SNPs)   Continue reading

Ehlers-Danlos receives new classification update

‘Most neglected disorder in modern medicine’ receives major classification update | The Ehlers Danlos Society

This long-awaited review updates the diagnostic criteria for the first time in 20 years, and provides management and care guidelines.

Full paper will be published
at http://ehlers-danlos.com/
on March 15th.

Latest Info 3/16
2017 EDS International Classification

Continue reading

Need for High Opioid Dose Linked to CYP450

Need for High Opioid Dose Linked to CYP450 | Medscape | September 25, 2012 by Nancy A. Melville

The problem of extreme variability in opioid metabolism has been known for years, yet is completely disregarded in creating more and more guidelines for standardized dosages.

Patients with chronic pain who require high doses of opioids to achieve pain relief show exceptionally high rates of defects of the cytochrome P450 (CYP450) enzyme system compared with the general population.

The CYP450 enzyme system is known to play an important role in the metabolism of opioids, and recent advances in genetic testing allow for the easy detection of defects to the enzymes.  Continue reading

Cytochrome P450 Testing In High-dose Opioid Patients

Cytochrome P450 Testing In High-dose Opioid Patients – Practical Pain Mgmt By Forest Tennant, MD, DrPH – October 26, 2012

This article gives a thorough explanation of how the genetics of this enzyme system affect opioid metabolism.

While it is common knowledge that the cytochrome P450 (CYP450) enzyme system is critical for the metabolism of some opioids, genotype testing of pain patients for CYP450 polymorphism has not been generally recommended.

This situation, however, may change as pain specialists begin to recognize that patients who require high doses of opioids may have a genetic defect that may affect their ability to metabolize these agents.

It is my recommendation, therefore, that patients who require more than 150 mg per day of morphine equivalents be tested for three specific CYP defects—2D6, 2C9, and 2C19.   Continue reading

Levorphanol: a Better Opioid?

Pain Experts Say Older Opioid Analgesic Levorphanol Provides Multiple Benefits – Pain Medicine News 11/4/16

As a single agent, the largely forgotten opioid analgesic levorphanol has several beneficial mechanisms for treating pain, according to a literature review of the drug dating back to the late 1940s.

Levorphanol (LevoCap ER, Relmada), which was approved by the FDA in 1953, is a mu-opioid receptor agonist that also acts on other important opioid receptors such as delta and kappa.

Additionally, the drug possesses NMDA (N-methyl-D-aspartate) antagonism, “which is known to have analgesic properties,” Dr. Gudin said

The drug also works like some antidepressants commonly used in pain management, “inhibiting the reuptake of both norepinephrine and serotonin,” Dr. Gudin said.   Continue reading

Epigenetic Changes in Post-Surgical vs Chronic Pain

Distinct Sets of Genes are Activated in Post-Surgical and Chronic Pain Conditions Clincial Pain Advisor – Florence Chaverneff, Ph.D. – December 02, 2016

The locations of epigenetic changes brought on by pain show how long-term pain affects numerous areas of our physical functioning, including:

  • neurodevelopment,
  • cell-mediated immune response,
  • amino acid metabolism,
  • humoral response (involves substances found in the humors, or body fluids), and
  • cell cycle.

Such epigenetic changes could be ameliorated if  the pain stimulation is blocked long enough (with opioids or whatever means necessary) to allow the changes to reverse themselves (as they do with acute pain).  Continue reading

One Gene Many Disorders: POTS, EDS, IBS, FM, ME/CFS, and more

One Gene Many Disorders: Genetic Finding Could Help Explain POTS, EDS, IBS, FM, ME/CFS and Others | Health RisingOct 20, 2016.

First, at least for me [Cort Johnson], there was chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM). Then I learned about irritable bowel syndrome (IBS), then POTS and in the last five years Ehler’s-Danlos (EDS) and Mast Cell Activation Syndrome (MCAS).

The more researchers looked the more they seemed to uncover a large group of syndromes which tended to flock together.

Anyone who has ME/CFS or FM now has to consider whether they also might have  Continue reading