Association between KCNJ6 (GIRK2) Gene Polymorphisms and Postoperative Analgesic Requirements after Major Abdominal Surgery

Opioids are commonly used as effective analgesics for the treatment of acute and chronic pain. However, considerable individual differences have been widely observed in sensitivity to opioid analgesics. We focused on a G-protein-activated inwardly rectifying potassium (GIRK) channel subunit, GIRK2, that is an important molecule in opioid transmission. In our initial polymorphism search, a total of nine single-nucleotide polymorphisms (SNPs) were identified in the whole exon, 5′-flanking, and exon-intron boundary regions of the KCNJ6 gene encoding GIRK2. Among them, G-1250A and A1032G were selected as representative SNPs for further association studies. In an association study of 129 subjects who underwent major open abdominal surgery, the A/A genotype in the A1032G SNP and -1250G/1032A haplotype were significantly associated with increased postoperative analgesic requirements compared with other genotypes and haplotypes. The total dose (mean±SEM) of rescue analgesics converted to equivalent oral morphine doses was 20.45±9.27 mg, 10.84±2.24 mg, and 13.07±2.39 mg for the A/A, A/G, and G/G genotypes in the A1032G SNP, respectively. Additionally, KCNJ6 gene expression levels in the 1032A/A subjects were significantly decreased compared with the 1032A/G and 1032G/G subjects in a real-time quantitative PCR analysis using human brain tissues, suggesting that the 1032A/A subjects required more analgesics because of lower KCNJ6 gene expression levels and consequently insufficient analgesic effects. The results indicate that the A1032G SNP and G-1250A/A1032G haplotype could serve as markers that predict increased analgesic requirements. Our findings will provide valuable information for achieving satisfactory pain control and open new avenues for personalized pain treatment

Examining Issues of Clinical Psychologists in Multidisciplinary Medical Teams : From a Survey on Clinical Psychologists

This study aimed to clarify issues faced by clinical psychologists in multidisciplinary medical teams. It examined three points: 1) the difficulties faced by clinical psychologists in multidisciplinary medical teams; 2) the skills and knowledge required in such teams; and 3) the areas in which graduate school education could be improved. The data used in the study was open data from surveys of clinical psychologists (N = 731). First, we conducted qualitative analysis of answers given to an open-ended question asking why collaboration among clinical psychologists remains undeveloped. Second, we conducted quantitative analysis of subjects’ responses to questions about the knowledge and skills useful for collaboration, and how they acquired these skills. The results indicated that 1) the personal characteristics of clinical psychologists, such as how flexible and sociable they are, can cause difficulties in multidisciplinary collaboration, so these “ non-professional ” skills need to be specifically taught, 2) “ assessment ” and “psychotherapy” are useful skills, but are mainly acquired through practice, and 3) education on skills application needs to be provided in graduate school