GENOMIC AND TRANSCRIPTOMIC PREDICTORS OF CHRONIC POST-SURGICAL PAIN FOLLOWING THORACIC AND HEAD AND NECK CANCER SURGERY

Abstract

Chronic post-surgical pain (CPSP) is a significant clinical problem after thoracic and head and neck cancer surgery, and chronic pain can adversely affect recovery, quality of life, and chronic opioid use. While surgical, anaesthetic, and psychosocial risk factors are well studied, there has emerged evidence that differences in genomic and transcriptomic variability may also contribute to susceptibility to chronic post-operative pain. This paper reviews the value of genetic and gene-expression-based markers for the detection of patients with a higher risk of CPSP after thoracic and head and neck oncologic surgery. Specific emphasis is placed on pain pathways involved in inflammation, nerve injury, opioid metabolism, immune regulation, and central sensitization. Single-nucleotide polymorphisms in pain modulation, cytokine and drug-response genes may account for inter-individual variation in pain persistence. Likewise, transcriptomic profiling can highlight the changes of expression related to nociceptive signalling, wound healing, and neuroimmune activation. Combining genomic and transcriptomic information with clinical, surgical, and treatment-related data could aid in the creation of precision pain prediction models. Such models might help to better risk stratify patients prior to surgery, create more personalized pain management plans, and minimize chronic pain after cancer surgery. The present study shows the promise of multi-omics technologies for improving the care of the patient during the perioperative period and underscores the importance of having larger prospective validation studies before clinical use.