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Burkill S, Smith KA, Stridh P, Kockum I, Hillert J, Lindahl H, Alfredsson L, Olsson T, Piehl F, Montgomery S, Bahmanyar S. The DQB1 *03:02 Genotype and Treatment for Pain in People With and Without Multiple Sclerosis. Front Neurol 2020; 11:993. [PMID: 33013655 PMCID: PMC7500133 DOI: 10.3389/fneur.2020.00993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
Murine models have demonstrated that the major histocompatibility complex (MHC) is associated with pain-like behavior in peripheral nerve injury, however, the same association has not been shown when considering injury to the central nervous system (CNS), which more closely mimics the damage to the CNS experienced by MS patients. Previous research has indicated the DQB1*03:02 allele of the class II HLA genes as being associated with development of neuropathic pain in persons undergoing inguinal hernia surgery or with lumbar spinal disk herniation. Whether this HLA allele plays a part in susceptibility to pain, has not, as far as we are aware, been previously investigated. This study utilizes information on DQB1*03:02 alleles as part of the EIMS, GEMS, and IMSE studies in Sweden. It also uses register data for 3,877 MS patients, and 4,548 matched comparators without MS, to assess whether the DQB1*03:02 allele is associated with prescribed pain medication use, and whether associations with this genotype differ depending on MS status. Our results showed no association between the DQB1*03:02 genotype and pain medication in MS patients, with an adjusted odds ratio (OR) of 1.02 (95% CI 0.85-1.24). In contrast, there was a statistically significant association of low magnitude in individuals without MS [adjusted OR 1.18 (95% CI 1.03-1.35)], which provides support for HLA influence on susceptibility to pain in the general population. Additionally, the effect of zygosity was evident for the non-MS cohort, but not among MS patients, suggesting the DQB1*03:02 allele effect is modified by the presence of MS.
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Affiliation(s)
- Sarah Burkill
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kelsi A Smith
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Pernilla Stridh
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Hannes Lindahl
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Shahram Bahmanyar
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
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Tomaras MC, Simmons SF, Schnelle JF, Charles D, Hacker ML. The Minimum Data Set: An Opportunity to Improve Spasticity Screening. J Am Med Dir Assoc 2020; 22:608-612. [PMID: 32893138 DOI: 10.1016/j.jamda.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Spasticity is a common movement disorder that arises from trauma or disease affecting the central nervous system. Untreated spasticity can result in limitations in completing activities of daily living, painful limb contractures, and other conditions associated with loss of mobility. In the long-term care setting, this treatable condition is prevalent, yet often unrecognized likely because of a lack of spasticity-trained practitioners. A recently published spasticity referral tool holds promise for addressing the underdiagnosis of spasticity in the long-term care population. The Minimum Data Set (MDS) would be an ideal mechanism for increasing the diagnosis and treatment of spasticity because it is a government-directed comprehensive screening tool that informs care plans for all residents residing in federally funded long-term care facilities. The MDS could easily integrate the published referral assessment to record the presence of spastic postures and muscle rigidity. We propose expanding the MDS to include 3 questions related to spasticity to improve the recognition and treatment of this prevalent and treatable condition.
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Affiliation(s)
- Miranda C Tomaras
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN.
| | | | | | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
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