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Up Front | Jun 2014

Medical Updates

Researchers Discover Genetic Link Between Chronic Pain Syndromes

A link among four common chronic pain syndromes has been discovered, suggesting that some individuals may be genetically predisposed to these conditions, according to a study published in Pain and reported in a news release.1

Frances Williams, MD, of King's College London, and colleagues examined more than 8,000 twins from the TwinsUK cohort using questionnaires about the patients' chronic pain symptoms. The sample compared groups of identical twins (sharing 100% of their DNA) and nonidentical twins (sharing 50% of their DNA).

The investigators found that irritable bowel syndrome, musculoskeletal pain, pelvic pain, and dry eye disease may have hereditary links. Migraine was shown to have a degree of susceptibility but was not genetically linked to the other conditions.

All of the chronic pain syndromes studied were more likely to be found in both twins in an identical pair than in the nonidentical group, suggesting that they are heritable. There was also a higher prevalence of chronic pain syndromes in females than in males. In a secondary analysis, different combinations of the chronic pain syndromes in female twin pairs showed that there were also stronger links between the syndromes in the identical group than in the nonidentical group.

“This study is one of the first to examine the role of genetic and environmental factors in explaining the links between different chronic pain syndromes,” Dr. Williams said in a King's College London news release. “The findings have clearly suggested that [chronic pain syndrome] may be heritable within families. With further research, these findings could then lead to therapies which may change the lives of those suffering with chronic pain.”

The overlap found between chronic pain syndromes in this study may be suggestive of an underlying genetic pathway common for all chronic pain syndromes and could lead to more effective targeted therapies in the future, the news release said.

  1. King's College London. Key genetic link between chronic pain conditions like IBS discovered [news release]. May 21, 2014. http://www.kcl.ac.uk/newsevents/news/newsrecords/2014/May/Key-genetic-link-between-chronicpain- conditions-like-IBS-discovered.aspx. Accessed May 22, 2014.

Older Individuals With Migraines At Higher Risk of Silent Stroke

Older individuals who have migraines may be twice as likely to have silent strokes, according to a study in Stroke.1

Teshamae Monteith, MD, of the University of Miami, and colleagues analyzed data from patients in the Northern Manhattan Study. Subclinical brain infarctions and white matter hyperintensity volume were quantified among those with self-reported migraine, confirmed by the International Classification of Headache Disorders-2 criteria.

Of the 546 patients with imaging and migraine data (41% men; mean age at magnetic resonance imaging, 71±8 years; 65% Hispanic), those reporting migraine had double the odds of subclinical brain infarcation (adjusted odds ratio [OR], 2.1; 95% CI, 1.0–4.2) when compared with those reporting no migraine, after adjustment for sociodemographic and vascular risk factors. No association was observed between migraine with or without aura and white matter hyperintensity volume, the investigators found.

“I do not believe migraine sufferers should worry, as the risk of ischemic stroke in people with migraine is considered small,” Dr. Monteith said in a University of Miami news release. “However, those with migraine and vascular risk factors may want to pay even greater attention to lifestyle changes that can reduce stroke risk, such as exercising and eating a low-fat diet with plenty of fruits and vegetables.”

  1. Monteith T, Gardener H, Rundek T, et al. Migraine, white matter hyperintensities, and subclinical brain infarction in a diverse community: The Northern Manhattan Study [published online ahead of print May 15, 2014]. Stroke. doi: 10.1161/ STROKEAHA.114.005447.

Urine Test May Help Detect Acute Pulmonary Embolism

A urine test may detect the presence of acute pulmonary embolism more accurately than the current blood test, according to research presented at the American Thoracic Society 2014 International Conference in San Diego.1

Timothy Fernandes, MD, MPH, of the University of California, San Diego, and colleagues have developed a urine test that measures the levels of fibrinopeptide B (FPB). FPB is released from fibrinogen in the process of thrombin-catalysed conversion to fibrin during thrombosis, and it is then rapidly cleared in the urine. In contrast, the blood test currently used to detect pulmonary embolism looks for a piece of a protein called a D-dimer, which appears in the blood as a clot begins breaking apart.

The investigators evaluated urine samples of 344 patients collected upon enrollment in the Pulmonary Embolism Diagnosis Study. The patients were considered at risk for an acute pulmonary embolism based on a Wells clinical model score of 4.5 or greater or a positive D-dimer assay result. The team evaluated the sensitivity, specificity, and negative likelihood ratio for three threshold levels of urine FPB: 2.5, 5, and 7.5 ng/mL.

Overall, 61 patients (18%) had pulmonary embolism, and 283 (83%) did not. Urine levels of FPB, at a threshold of 2.5 ng/mL, showed a sensitivity of 75.4% (95% CI, 62.4%– 85.2%), a specificity of 28.9% (95% CI, 23.8%–34.7%), and a negative likelihood ratio of 0.18 (95% CI, 0.11–0.29) for pulmonary embolism. The thresholds of 5 and 7.5 ng/mL had sensitivities of only 55.7% (95% CI, 42.5%–68.2%) and 42.6% (95% CI, 30.3%–55.9%), respectively.

Future studies are reportedly planned to better evaluate urine FPB in other settings where D-dimer is used.

  1. Fernandes T. Urine fibrinopeptide B as a screening test for acute pulmonary embolism. Paper presented at: the American Thoracic Society 2014 International Conference. May 18, 2014; San Diego.

Early Antibiotic Use Associated With Childhood Asthma

Antibiotic use in the first year of life may be associated with an increased risk of early-onset childhood asthma, a study in Annals of Allergy, Asthma & Immunology suggests.1

Mei-Sing Ong, PhD, of the Australian Institute for Health Innovation and Boston Children's Hospital, and colleagues conducted a retrospective, population-based study of a cohort of children enrolled in a nationwide employerprovided health insurance plan from January 1999 to December 2006 in the United States (n=62,576). The investigators evaluated the association between antibiotic exposure during the first year of life and subsequent development of three asthma phenotypes: (1) transient wheezing (begun and resolved before 3 years of age), (2) late-onset asthma (begun after 3 years of age), and (3) persistent asthma (begun before 3 years of age and persisting through 4 to 7 years of age).

Antibiotic use in the first year of life was associated with the development of transient wheezing (OR, 2.0; 95% CI, 1.9–2.2; P<.001) and persistent asthma (OR, 1.6; 95% CI, 1.5–1.7; P<.001). A dose-response effect was observed. When five or more antibiotic courses were received, the odds of persistent asthma doubled (OR, 1.9; 95% CI, 1.5–2.6; P<.001). There was no association between antibiotic use and late-onset asthma.

“Heightened caution about avoiding unnecessary use of antibiotics in infants is warranted,” the authors wrote.

  1. Ong MS, Umetsu DT, Madl KD. Consequences of antibiotics and infections in infancy: bugs, drugs, and wheezing. Ann Allergy Asthma Immunol. 2014;112(5):441-445.

—Compiled by Callan Navitsky, Senior Editor

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