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Genetics can dictate patient response to pain medicine


genes pain rahman

Among my patients, I have observed differences in how individuals respond to opioids, a commonly prescribed type of narcotic pain medication. Just as people differ in hair, skin and eye color, they also can experience different results from pain medications.

For some patients, a particular medicine—and even a specific dosage—may work well. For others, the exact same amount and drug type may offer little relief. When assessing an individual’s response to a particular drug, genetic factors can be as important as any other factor, such as age, sex, weight and overall health.

At CTCA, our physicians use genetic testing to determine if patients carry specific gene mutations. We offer genomic tumor assessment to learn what’s driving the growth of an individual patient’s tumor. Both types of diagnostic tests help our physicians tailor treatment options to the individual.

Similarly, genetic testing can bring more personalized care to pain management. Consider the impact of medicines metabolized, or processed through the body, at different rates:

  • Drugs that are metabolized slowly may not relieve a patient’s pain and could result in adverse effects, which are both undesirable and harmful.
  • Drugs that are metabolized too quickly also may not relieve a patient’s pain because the patient has metabolized the medicine before it can do its job. In this case, the patient needs higher dosage.

An enzyme known as CYP2D6 is responsible for activating many pain medications to make them effective. Yet it’s estimated that the genetic makeup of many patients changes how this enzyme works. Testing patients for gene alterations would allow pain specialists to identify the proper dosage needed to help make the drug as effective as it is in someone whose CYP2D6 gene functions normally.

Pharmacogenomics plays an important role helping us understand the role of genetic testing in pain medicine. Pharmacogenomics is the science that examines genetic variations that dictate drug response. New knowledge in this field will better predict if a patient will have a positive or negative response to a pain medicine, or if that patient will have no response at all.

Ultimately, pharmacogenomics can lead to safer and more effective prescribing and dosing. Genetic testing holds promise for us, as pain management specialists, to design care plans that are personalized down to the very DNA of our patients. Using genetic testing, our goal is to prescribe medications that are appropriate from the start, avoiding the trial-and-error process that creates frustration among many patients.

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