We’ve already learned that genetics can put us at risk for a wide variety of maladies, from diabetes to heart disease. But researchers now say there may be another ailment to add to the list of things we inherit from our parents: chronic pain following a car wreck.
Understanding the genetics of pain is important because people are less likely to seek treatment following traffic accidents when their injuries are dismissed by doctors as psychological, says Dr. Sam McLean, an assistant professor of anesthesiology and emergency medicine at the University of North Carolina.
When car accident victims suffer from lingering pain that can’t be explained medically, they often wrongly are dismissed as people who are faking or people with mental disorders, he says.
“There is really big medical-legal contention, a whole lot of battles between lawyers,” McLean says. “My research group used genetic factors to try to get an idea of what biologic systems in the body are responsible for this pain development.”
Looking for better pain treatments
Genes function much like a set of biological instructions, to determine how we develop and behave. The goal of two recent studies by McLean and his colleagues was to determine, through blood samples, whether genetic differences explain why some people experience more pain than others. The hope is that identifying the genes responsible for such pain will lead to more effective treatments.
The researchers studied 948 patients who visited eight emergency rooms in four states after auto accidents. Participants provided blood samples. The extent and severity of their pain symptoms were assessed and reviewed in follow-up interviews six weeks later.
Researchers discovered that some of the patients shared genetic factors that influence the brain’s production of dopamine, a chemical related to how the central nervous system functions. The findings of this study suggest that pathways involving the one of the brain’s dopamine receptors contribute to the intensity of pain experienced immediately after a car wreck, McLean says.
Researchers also examined the role of the hypothalamic-pituitary adrenal axis, a system important to the body’s response to stressful events. Findings revealed that a gene variation was associated with a 20 percent higher risk of moderate to severe neck pain six weeks after a car accident, as well as a greater degree of body pain.
Who truly needs care?
Nina Kallen, a Massachusetts attorney who handles insurance cases, is skeptical of the findings. In some cases, pain may be caused by heredity, she says, but sometimes plaintiffs exaggerate their symptoms to seek larger auto insurance settlements.
“It could be the family has weak spines, or it could be that they are brought up to fake claims,” she says. “There are a lot of ways to look at that.”
Dr. Mark Borigini, a rheumatologist at the National Institutes of Health in Maryland, says the genetics study by the University of North Carolina group could be helpful in properly diagnosing patients who suffer persistent pain.
It’s important to invest medical resources in people with physical problems, “as opposed to those who could stand to go to some psychotherapy sessions,” Borigini says.
Before you can recover from any injury, you need to have a way to pay for your treatment. If you are injured in a car accident, typically the first thing that kicks in is your health insurance policy, not your auto insurance, says Pete Moraga, a spokesman for the nonprofit Insurance Information Network of California. If someone else caused the accident, your health insurance company likely will seek compensation from that person’s insurer.
Making sure you have adequate insurance
Nearly every state requires minimum levels of auto liability insurance that pay for the losses you cause to others, including property damage and injuries. This insurance also will pay for your legal bills if you’re at fault.
According to the nonprofit Insurance Information Institute, 12 states and Puerto Rico have no-fault auto insurance laws. If you live in a no-fault state, you’re required to buy either personal injury protection (PIP) or medical payments (“medpay”) coverage.
PIP and medpay cover the medical bills for you and your passengers following a crash, no matter who’s to blame.
“No-fault states try to keep small disputes over car accidents out of court,” says Mike Barry, a spokesman for the Insurance Information Institute.
In no-fault states, motorists are allowed to sue for injuries as well as for pain and suffering only if the injuries are considered under state law to be serious enough, Barry says. “There is a certain threshold,” he says.
No-fault coverage varies from state to state. In states with strong no-fault requirements, the insured motorist may receive compensation for medical bills, lost wages, funeral costs and other out-of-pocket expenses. There are variations on policy limits.
Barry notes that in at-fault states – which do not require PIP or medpay – you can get by with simply buying liability coverage. To make sure you’re fully protected, Kallen advises drivers to buy uninsured and underinsured motorist coverage. Those policies take effect when at-fault drivers lack insurance to pay for your losses.
Because state laws governing auto insurance coverage are complex, you should check with your insurance agent or state insurance department to understand your state’s mandatory requirements, says Jack Hungelmann, author of the book “Insurance for Dummies.”