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Neuropathic pain as part of chronic widespread pain: environmental and genetic influences

Momi, Sukhleen K.; Fabiane, Stella Maris; Lachance, Genevieve; Livshits, Gregory; Williams, Frances M. K.

doi: 10.1097/j.pain.0000000000000277
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Chronic widespread pain (CWP) has complex aetiology and forms part of the fibromyalgia syndrome. Recent evidence suggests a higher frequency of neuropathic pain features in those with CWP than previously thought. The aim of this study was to determine the prevalence of neuropathic pain features in individuals with CWP and to estimate the influence of genetic and environmental factors on neuropathic pain in CWP. Validated questionnaires (the London Fibromyalgia Screening Study questionnaire and PainDETECT questionnaire) were used to classify twins as having CWP and neuropathic pain, respectively. The prevalence of CWP was 14.7% (n = 4324), and of the 1357 twins invited to complete neuropathic pain screening, 15.9% of those having CWP demonstrated features of neuropathic pain. Neuropathic pain was found to be heritable (A = 37%; 95% confidence interval [CI]: 23%-50%) with unique environmental factors accounting for 63% (95% CI: 49%-79%) of the variance. Heritability of neuropathic pain and CWP were found to be correlated, 0.54 (95% CI: 0.42-0.65). Increasing age, raised body mass index, female gender, and smoking were all risk factors for neuropathic pain (P < 0.05), and CWP (P < 0.05). High socioeconomic status showed negative correlation with neuropathic pain (P = 0.003) and CWP (P = 0.001). Bivariate analysis of the 2 pain traits revealed that genetic predisposition to neuropathic pain is shared with that for CWP. This is the first study to provide formal heritability estimates for neuropathic pain in CWP. The findings suggest that at least some of the genetic factors underlying the development of neuropathic pain and CWP are the same.

Supplemental Digital Content is Available in the Text.The prevalence of neuropathic pain within chronic widespread pain is 16%. Neuropathic pain is 37% heritable and shares underlying genetic factors with chronic widespread pain.

aDepartment of Twin Research and Genetic Epidemiology, St Thomas' Hospital, King's College London, London, United Kingdom

bDepartment of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Corresponding author: Department of Twin Research and Genetic Epidemiology, St Thomas' Hospital, King's College London, Westminster Bridge Road, London SE1 7EH, United Kingdom. +44 (0) 20 7188 6765; fax: +44 (0) 20 7188 6761. E-mail address: frances.williams@kcl.ac.uk.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received May 01, 2015

Received in revised form June 16, 2015

Accepted June 17, 2015

© 2015 International Association for the Study of Pain
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