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Association between lymphocyte expression of the apoptotic receptor Fas and pain in critically ill patients.

Abstract：

OBJECTIVE:Lymphocyte apoptosis in critical illness is associated with immunosuppression. We explored for the first time the associations between pain ratings and expression of the apoptotic receptor Fas on B and T cells in critically ill patients and the potential mediating effects of adrenocorticotropic hormone (ACTH), cortisol, and substance P (SP). DESIGN:This is an exploratory correlational study with repeated measurements (14 days followup) and cross-sectional comparisons. SETTING:This study was conducted in a state hospital in the metropolitan area of Athens, Greece. PARTICIPANTS:The participants were 36 consecutive critically ill patients and 36 matched controls. OUTCOME MEASURES:Pain measured by the self-reported numeric rating scale [NRS], the behavioral pain scale, and the pain assessment scale was the primary outcome measure. Flow cytometry (Fas), electrochemiluminescence (ACTH and cortisol) and enzyme-linked immunosorbent assay (SP) were used. Mixed linear models for repeated measurements and bivariable associations at discrete time points were employed. RESULTS:Significant pain at rest was noted. Pain ratings associated with Fas expression on cytotoxic T cells (P=0.041) and B cells (P=0.005), even after adjustment for a number of clinical treatment factors (P=0.006 and P=0.052, respectively). On the day that more patients were able to communicate, Fas on B cells (r=0.897, P=0.029) and cytotoxic T cells (r=0.832; P=0.037) associated with NRS ratings. Associations between pain ratings and ACTH serum levels were noted (P<0.05). When stress neuropeptide levels were added to the model, the statistical significance of the associations between pain ratings and Fas expression was attenuated (P=0.052-0.063), suggesting that stress neuropeptides may partially mediate the association. CONCLUSION:Preliminary evidence for the association between pain and lymphocyte apoptotic susceptibility is provided. The role of pain management in maintaining immunocompetence in critical illness is worth exploring.

journal_name

J Pain Res

journal_title

Journal of pain research

authors

Papathanassoglou E,Mpouzika MD,Giannakopoulou M,Bozas E,Middleton N,Tsiaousis G,Karabinis A

doi

10.2147/JPR.S118105

subject

Has Abstract

pub_date

2017-01-13 00:00:00

pages

175-181

issn

1178-7090

pii

jpr-10-175

journal_volume

pub_type

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Association between lymphocyte expression of the apoptotic receptor Fas and pain in critically ill patients.