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Pain. 2019 Feb 6. doi: 10.1097/j.pain.0000000000001514. [Epub ahead of print]

Insight into the genetic architecture of back pain and its risk factors from a study of 509,000 individuals.

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Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London,UK.
Novosibirsk State University, Faculty of Natural Sciences, Novosibirsk, Russia.
Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russia.
PolyOmica, 's-Hertogenbosch, The Netherlands.
Department of Medical Genetics, University of Washington, Seattle, USA.
Seattle Epidemiologic Research and Information Center (ERIC), Veterans Affairs Office of Research and Development, Seattle, USA.
Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, USA.
Department of Rehabilitation Medicine, University of Washington, Seattle, USA.


Back pain (BP) is a common condition of major social importance and poorly understood pathogenesis. Combining data from the UK Biobank and CHARGE consortium cohorts allowed us to perform a very large GWAS (total N = 509,070) and examine the genetic correlation and pleiotropy between BP and its clinical and psychosocial risk factors. We identified and replicated three BP associated loci, including one novel region implicating SPOCK2/CHST3 genes. We provide evidence for pleiotropic effects of genetic factors underlying BP, height, and intervertebral disc problems. We also identified independent genetic correlations between BP and depression symptoms, neuroticism, sleep disturbance, overweight, and smoking. A significant enrichment for genes involved in central nervous system and skeletal tissue development was observed. The study of pleiotropy and genetic correlations, supported by the pathway analysis, suggests at least two strong molecular axes of BP genesis, one related to structural/anatomic factors such as intervertebral disk problems and anthropometrics; and another related to the psychological component of pain perception and pain processing. These findings corroborate the current biopsychosocial model as a paradigm for BP. Overall, the results demonstrate BP to have an extremely complex genetic architecture that overlaps with the genetic predisposition to its biopsychosocial risk factors. The work sheds light on pathways of relevance in the prevention and management of LBP.

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