Hypnosis is an effective pain treatment for many people, but determining which patients will benefit the most can be difficult. Hypnotism testing requires specialized training and personal assessment rarely available in the clinical setting. Now, researchers have developed a rapid point-of-care molecular diagnostic test that identifies a subset of people who are most likely to benefit from hypnosis interventions to treat pain. Their study, in The Journal of Molecular Diagnosticspublished by Elsevier, also found that a subset of highly hypnotizable individuals may be more likely to experience high levels of postoperative pain.
“Given that hypnotism is a stable cognitive trait with a genetic basis, our goal was to create a molecular diagnostic tool to objectively identify individuals who would benefit from hypnosis by determining ‘treatability’ at the point of care,” explained the lead researcher. Dana L. Cortade, recently graduated PhD in Materials Science and Engineering, School of Engineering, Stanford University, Stanford, CA, USA. “Advancement of non-pharmacological adjunctive pain therapies is of utmost importance in light of the opioid epidemic.”
Previous research has shown that the genetic basis for hypnotism involves four specific single nucleotide polymorphisms (SNPs), or genetic variants, found in catechol-o-methyltransferase (COMT) gene for an enzyme in the brain responsible for the metabolism of dopamine in the prefrontal cortex. Although SNPs can contain valuable information about disease risk and response to treatment, widespread use in clinical practice is limited due to the complexity, cost, and time delays involved in sending samples to laboratories for testing.
The researchers developed a SNP genotyping assay in a giant magnetoresistance (GMR) biosensor array to detect the optimal combination of COMT SNPs in patient DNA samples. GMR biosensor arrays are reliable, cheaper, sensitive, and can be easily deployed in point-of-care settings using saliva or blood samples.
The study investigated the correlation between COMT duplicates and hypnotizability using a clinical hypnotizability scale called the Hypnotic Induction Profile (HIP) in subjects who had participated in one of the three previous clinical trials in which HIP was administered. An additional exploratory study of the association between perioperative pain, COMT genotyping and HIP scores were performed on patients in the third cohort who had undergone 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 who identify with optimal COMT duplicates from the GMR biosensor array, 89.5% scored high on HIP, which detected 40.5% of the treatable population. The best COMT The mean HIP score of the group was significantly higher than that of the suboptimal group COMT club. 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 hypnotism and COMT The genotypes were stronger in the females of the cohort,” said study leader Jessie Markovits, MD, Department of Internal Medicine, Stanford School of Medicine, Stanford, CA, USA. “The difference may be due to the lower number of males in the cohort, or because COMT It is known to have interactions with estrogen and to differ in activity by gender. Additional gene targets incl COMTwith gender stratification, could be the focus of future study.”
In the exploratory analysis of the relationship between COMT genotypes and pain after TKA surgery, same optimal COMT Subjects had significantly higher postoperative pain scores than the suboptimal group, indicating a greater need for treatment. “This supports the body of evidence that COMT genotypes influence pain and it is also known that COMT genotypes influence 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 treatment: hypnosis,” said Dr. Cortade.
COMT SNPs alone are not a complete biomarker for identifying all individuals who will score high on a hypnotic scale and experience high pain sensitivity. The GMR sensor nanoarray can accommodate up to 80 SNPs, and it is likely that other SNPs, such as those for dopamine receptors, are needed to further stratify individuals.
The researchers note that this study highlights the utility and potential of the evolving applications of precision medicine. “It’s a step toward enabling researchers and healthcare professionals to identify a subset of patients who are more likely to benefit from hypnotic analgesia,” said Dr. Markowitz. “Precision medicine has made great strides in identifying differences in drug metabolism that can influence medication decisions for perioperative pain. We hope to provide similar precision in offering hypnosis as an effective, non-pharmacological treatment that can improve patient comfort patient while reducing opioid use.”