Genetic Predisposition: FKBP5 Gene Variant Influences Chronic Pain And Panic Disorder Following Minor Injury in MVA

Automobile accident is the most common cause of fatal and non-fatal injuries. Injuries sustained following motor vehicle accident are either minor or major. Major injuries such as fracture, dislocation, muscle tears, abdominal injuries, severe bleeding and rib fracture results in chronic pain and prolonged treatment. Few patients after major or minor injuries suffer with post-traumatic stress disorder (PTSD). Patient with minor injuries not needing any treatments for physical trauma may need long-term therapy for post-traumatic stress or panic disorder. Patient with minor injuries suffering with stress disorder often feels somatic symptoms are intensified. Somatic symptoms such as pain, joint aches and muscle aches are often inflated and overstated, nevertheless injury is considered minor. Findings of investigations, radiological studies and lab studies may not concur with the intensity of pain. Patients are often labelled as exaggerating the symptom or pain is in head or even malingering (acting). Cost of diagnosis and treatment of such symptoms is substantial. Recent genetic studies involving patients suffering with chronic pain and PTSD suggests symptoms are real in few minor injured victims because of genetic conversion of symptoms to higher intensity. FKBP5 gene variant were observed in victims of automobile accident who were suffering with chronic pain, PTSD and panic disorder. Research suggests FKBP5 gene variant influences chronic pain and panic disorder in patients suffering with minor injuries following automobile accident.

Automobile accident may happen because of several reasons such as speeding, unable to concentrate, tired, drowsiness, unable to see, unable to read the signal or secondary to side effects of alcohol or illicit drugs. Driver or passenger is often unaware of accident or impact. Every accident is not a serious accident. Every injured person is not seriously injured and bodily injuries could be minor or major. The emotional trauma caused by fear of death following impact can be considerable resulting in psychological alteration of behavior in few drivers or passengers.

In most of the motor vehicle accident physical injuries coincides with level of impact or vehicle damage. In contrast psychological injuries may not correlate with level of impact or severity of car damage. Bodily injuries such as brain laceration or bleeding is symptomatic and often detectable through MRI or CAT scan. Level of brain damage correlates with level of impact and vehicle destruction, but psychological damage often does not correlate to the level of automobile demolition. In few instances, minor automobile accident may result in severe psychological illnesses such as post-traumatic or panic disorder. In contrast majority of accident victims following minor injuries do not suffer with chronic pain or psychological illnesses. Post accident suffering of devastating chronic pain associated with PTSD or panic disorder after minor or not major automobile accident was always judged as exaggeration of symptoms. Cause of such post traumatic chronic pain after minor accident were not supported by any lab studies or radiological investigation The illness was often diagnosed as symptoms of mystery. Lack of radiological evidence of trauma was used against the patient to deny any treatment. Insurance provider often request or demand Independent Medical Evaluation (IME). IME are done by expert physician and paid by insurance provider. The general opinion is IME often sides with payers. IME expert defend their reports by suggesting no evidence of any abnormalities were found in any investigation or lab test. The outcome of IME is often denial of treatment. The medical report and evaluation of treating physician is ignored until patient files a lawsuit. Injured victims genuinely suffering with devastating psychological symptoms now do not get any medical attention or treatment until the dispute is settled. Victims of car accident may be eligible for treatment using his personal, Medicare or Medicaid Insurance. The disease over the time often gets worse. Hopefully in near future study of FKBP5 gene variant may be one of the diagnostic studies performed in patients suffering with minor injuries.

Majority of drivers and passengers (over 40%) following automobile accident do not seek any medical attention. Some discontinue medical treatment after initial investigation and treatment. Few patients suffer with severe pain immediately following accident, which subsides in few hours. Pain is substantial in few patients following collision, needing immediate and continuous treatment.

Scientific study has revealed gene variants in victims of automobile accident suffering with panic disorder. Origination of fear at the time of accident frequently follows traumatic stress disorder and pain. Published scientific research involving thirty patients suggests trauma causes acute panic disorder.¹ Symptoms of panic disorder are observed following trauma and persists for prolonged period. Prolonged panic disorder results in dysfunctional interpretations of somatic stimuli.¹ Most of the symptoms are intensified and mistaken as exaggerated complaints.

Post-traumatic stress disorder is frequently seen with chronic pain and panic disorder following car accident. Intensity of symptoms increases with stress. Panic condition results in lack of confidence, which interferes with job performance. Study published in 2013 of 886 injured road-accident victims of age 16 years and above suggest deterioration of quality of life and awful impact on occupational career. Cause of these changes were secondary to chronic pain and post-traumatic disorder.

Recent research study done in 2012 was presented at the annual meeting of American Society of Anesthesiology. Study suggests exaggeration of pain symptoms following automobile accident in some patients were secondary to hereditary genes. Researchers from the University of North Carolina collected data from 838 patients who came to one of eight emergency departments in four states for care after an MVC (Motor Vehicle Collision). Clinical examination and blood test were performed.

Findings revealed the FKBP5 gene variant was associated with a 20 percent higher risk of moderate to severe neck pain six weeks after an MVC (Motor Vehicle Collision), as well as a greater extent of body pain. Study had included 9339 patients suffered with automobile accident and 1584 were eligible for study. Only 838 patients had genotyped study.

Study concluded FKBP5 variants predicts pain six weeks after minor MVC.³

Genetic influence on pain was studied by Bortsov AV and colleagues. Generalized and neck pain was assessed 6 weeks after the motor vehicle accident. Pain data was compared and analyzed with genetic data. The scientific study suggests association of 6 FKBP5 polymorphisms with patient suffering with generalized pain and neck pain.⁴

Reference:

1. Peritraumatic and persistent panic attacks in acute stress disorder.
Nixon RD, Bryant RA.
PMID: 19941177 [PubMed – indexed for MEDLINE Behav Res Ther. 2003 Oct;41(10):1237-42.
University of New South Wales, School of Psychology, University of New South Wales, NSW 2052, Australia.
2. Outcomes one year after a road accident: Results from the ESPARR cohort.
Hours M, Chossegros L, Charnay P, Tardy H, Nhac-Vu HT, Boisson D, Luauté J, Laumon B.
Accid Anal Prev. 2013 Jan;50:92-102. doi: 10.1016/j.aap.2012.03.037. Epub 2012 May 2.
Université de Lyon, F-69622 Lyon, France.
3. FKBP5 Variants Predict Neck Pain Persistence 6 Weeks After Motor Vehicle Collision
Jennifer Smith, B.S., Jacob Ulirsch, B.S., Andrey Bortsov, M.D.,Ph.D., Robert Swor, D.O., David Peak, M.D., Jeffrey Jones, M.D., Niels Rathlev, M.D., Luda Diatchenko, M.D.,Ph.D., Samuel McLean, M.D.,M.P.H.
UNC-Chapel Hill, Chapel Hill, North Carolina, United States
4. Polymorphisms in the glucocorticoid receptor co-chaperone FKBP5 predict persistent musculoskeletal pain after traumatic stress exposure.
Bortsov AV, Smith JE, Diatchenko L, Soward AC, Ulirsch JC, Rossi C, Swor RA, Hauda WE, Peak DA, Jones JS, Holbrook D, Rathlev NK, Foley KA, Lee DC, Collette R, Domeier RM, Hendry PL, McLean SA., Pain. 2013 Aug;154(8):1419-26. doi: 10.1016/j.pain.2013.04.037.
TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.