The unusual case of a Scottish patient with no sensitivity to pain

  • Br J Anaesth

  • curated by Dawn O'Shea
  • UK Medical News
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Clinicians at University College London have, this week, reported the unusual case of a 66-year-old woman in Scotland who feels virtually no pain as a result of a previously unknown mutation in fatty-acid amide hydrolase (FAAH) chromosomal region.

The patient presented with nil requirement for postoperative analgesia after a trapeziectomy, which normally a condition requiring significant analgesia in the post-operative period. She also experienced very little anxiety and fear.

Further investigations revealed a lifelong history of painless injuries, with frequent cuts and burns, which were observed to heal quickly.

The cause of the condition was found to be the co-inheritance of a microdeletion in dorsal root ganglia and brain-expressed pseudogene (FAAH-OUT), which was cloned from the FAAH chromosomal region; and a common functional single-nucleotide polymorphism in FAAH conferring reduced expression and activity.

Circulating concentrations of anandamide and related fatty-acid amides (palmitoylethanolamide and oleoylethanolamine) that are all normally degraded by FAAH were significantly elevated in peripheral blood compared with normal control carriers of the hypomorphic single-nucleotide polymorphism.

The authors say the genetic findings and elevated circulating fatty-acid amides are consistent with a phenotype resulting from enhanced endocannabinoid signalling and a loss of function of FAAH.

They say the case suggests new routes to develop FAAH-based analgesia by targeting FAAH-OUT, which could significantly improve the treatment of postoperative pain and potentially chronic pain and anxiety disorders.

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