epigenetics & bias (9/24)

implicit bias

unconscious cognitive shortcuts and attitudes that influence our understanding, actions, decisions without intentional malice

implicit bias in practice

referral rates & access: referrals based on race, insurance, age, rehab potential

pain assessment and credibility: pain validation, imaging orders, rx intensity

expectations and goal setting: lower expectations based on SES or language

epigenetics

how experience speaks to genetics/how DNA is expressed

DNA is fixed

genome (all of DNA) is a complete library

epigenome is bookmarks on a page

epigenetics determine which chapters are easily read (expressed) and which are clipped shut (silenced)

DNA methylation

addition of a methyl group to DNA that acts as a “silencer” of that gene

adverse childhood experiences

chronic early-life psychosocial stress

potentially causes altered methylation for a stress-responsive gene

impaired hormone release in response to stress

slow, persistent, cumulative (months, years)

science is still developing

clinical manifestation of altered gene methylation

central sensitization: lowered nociceptive thresholds, altered pain processing

impaired tissue healing: delayed recovery, postop/chronic conditions

movement dysfunction: guarding, elevated mm tone, altered motor control

positive epigenetic adaptation

through exercise remodeling

fast, highly responsive (hours, days)

histone modification (acetylation)

DNA wound tightly around histones (protein)

chemical tags on histones (acetyl groups) ccan loosen or tighten winding

looser winding=gene is physically accessible and easier to “read” (more expression)

tighter winding=harder to access (less expression)

gene remodeling via exercise

single bout or sustained training triggers histone to exit muscle cell nucleus, removing inhibition of genes