New test quickly identifies patients whose postoperative pain can be effectively treated with hypnosis

Summary: A new molecular diagnostic test is able to identify those most likely to benefit from hypnosis to help manage post-surgery pain. This subset of highly hypnotizable people is also more likely to experience higher levels of postoperative pain.

Source: Elsevier

Hypnosis is an effective pain treatment for many people, but determining which patients will benefit the most can be difficult. Hypnotizability testing requires special training and in-person assessment rarely available in a clinical setting.

Now, researchers have developed a rapid point-of-care molecular diagnostic test that identifies a subset of individuals most likely to benefit from hypnosis interventions for the treatment of pain.

Their study, in The Journal of Molecular Diagnostics also found that a subset of highly hypnotizable individuals may be more likely to experience high levels of postoperative pain.

“Since hypnotizability is a genetically based stable cognitive trait, our goal was to create a molecular diagnostic tool to objectively identify people who would benefit from hypnosis by determining ‘treatability’ at the point of care,” said explained the co-principal investigator. Dana L. Cortade, recent Ph.D. graduate in Materials Science and Engineering, School of Engineering, Stanford University, Stanford, CA, USA.

“The advancement of non-pharmacological adjuvant treatments for pain is of utmost importance in light of the opioid epidemic.”

Previous research has established that the genetic basis of hypnotizability includes four specific single nucleotide polymorphisms (SNPs), or genetic variations, found in catechol-o-methyltransferase (COMT) gene for a brain enzyme responsible for dopamine metabolism in the prefrontal cortex.

Although SNPs can hold valuable information about disease risk and treatment response, their widespread use in clinical practice is limited due to the complexity, cost, and time involved in sending samples to laboratories. for analysis.

Researchers developed an SNP genotyping assay on a giant magnetoresistive (GMR) biosensor array to detect the optimal combination of COM SNPs in DNA samples from patients. GMR biosensor arrays are reliable, less expensive, sensitive, and can be easily deployed at point-of-care using saliva or blood samples.

The study examined the association between COM diplotypes and hypnotizability using a clinical scale of hypnotizability called the Hypnotic Induction Profile (HIP) in people who participated in one of three previous clinical trials in which a HIP was administered.

A complementary exploratory study of the association between perioperative pain, COM genotypes, and HIP scores were performed in patients of the third cohort who underwent total knee arthroplasty (TKA).

DNA was extracted from blood samples previously collected in the first cohort, and saliva samples were collected by mail from participants in the other two trials. Participants were considered treatable with hypnosis if they had HIP scores of 3 or higher on a scale of zero to 10.

For participants identified with the COM diplotypes by the GMR biosensor network, 89.5% scored high on the HIP, which identified 40.5% of the treatable population. The optimum COM the mean HIP score of the group was significantly higher than that of the suboptimal COM band. Interestingly, further analysis revealed that the difference was only seen in women.

“Although we expected some difference in effect between women and men, the association between hypnotizability and COM genotypes were strongest in females in the cohort,” said co-principal investigator Jessie Markovits, MD, Department of Internal Medicine, Stanford School of Medicine, Stanford, CA, USA.

“The difference may be due to the lower number of men in the cohort, or because COM is known to have interactions with estrogen and to have different activity depending on the sex. Additional genetic targets, including COMwith a stratification by sex, could be the subject of a future study.

In the exploratory analysis of the relationship between COM genotypes and pain after PTG surgery, the same optimal COM individuals had significantly higher postoperative pain scores than the suboptimal group, indicating a greater need for treatment.

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The GMR sensor nanoarray can accommodate up to 80 SNPs, and it is possible that other SNPs, such as those for dopamine receptors, are required to further stratify individuals. Image is in public domain

“This confirms all the evidence that COM genotypes have an impact on pain, and it is also known that COM genotypes affect opioid use after surgery. Pain researchers can use this technology to correlate genetic predisposition to pain sensitivity and opioid use with response to an evidence-based alternative remedy: hypnosis,” said Dr Cortade. .

COM SNPs alone are not a complete biomarker to identify all individuals who will score high on a hypnotizability scale and experience high pain sensitivity. The GMR sensor nanoarray can accommodate up to 80 SNPs, and it is possible that other SNPs, such as those for dopamine receptors, are required to further stratify individuals.

The researchers note that this study highlights the utility and potential of the evolving applications of precision medicine.

“This is a step for researchers and healthcare professionals to identify a subset of patients most likely to benefit from hypnotic analgesia,” Dr. Markovits said.

“Precision medicine has made great strides in identifying differences in drug metabolism that can impact medication decisions for perioperative pain. We hope to provide similar accuracy by proposing hypnosis as an effective, non-pharmacological treatment that can improve patient comfort while reducing opioid consumption.

About this pain, hypnosis and neurotechnology research news

Author: Eileen Leahy
Source: Elsevier
Contact: Eileen Leahy – Elsevier
Picture: Image is in public domain

Original research: Free access.
“Point-of-care testing of enzyme polymorphisms to predict hypnotizability and postoperative pain” by Dana Cortade et al. Molecular Diagnostic Journal


Point-of-care testing of enzyme polymorphisms to predict hypnotizability and postoperative pain

Hypnotizability is a stable trait that moderates the benefits of hypnosis for pain treatment, but the limited availability of hypnotizability testing discourages the widespread use of hypnosis. Inexpensive genotyping of four catechol-o-methyltransferase single nucleotide polymorphisms (COM) was performed using giant magnetoresistive biosensors to determine whether hypnotizable individuals can be identified for targeted hypnosis referrals.

For people with the proposed optimum COM diplotypes, 89.5% scored high on the hypnotic induction profile (odds ratio, 6.12; 95% CI, 1.26-28.75), which identified 40.5% of the population treatable.

Mean hypnotizability scores of the optimal group were significantly higher than those of the total population (P = 0.015; effect size = 0.60), an effect that was present in women (P = 0.0015; effect size = 0.83), but not in men (P = 0.28).

In an exploratory cohort, optimal individuals also reported significantly higher postoperative pain scores (P = 0.00030; effect size = 1.93), indicating a greater need for treatment.

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