Personalized therapy in pain management: where do we stand?
Genomic variations influencing response to pharmacotherapy of pain are currently under investigation. Drug-metabolizing enzymes represent a major target of ongoing research in order to identify associations between an individual's drug response and genetic profile. Polymorphisms of the cytochrome P450 enzymes (CYP2D6) influence metabolism of codeine, tramadol, hydrocodone, oxycodone and tricyclic antidepressants. Blood concentrations of some NSAIDs depend on CYP2C9 and/or CYP2C8 activity. Genomic variants of these genes associate well with NSAIDs' side effect profile. Other candidate genes, such as those encoding (opioid) receptors, transporters and other molecules important for pharmacotherapy in pain management, are discussed; however, study results are often equivocal. Besides genetic variants, further variables, for example, age, disease, comorbidity, concomitant medication, organ function as well as patients' compliance, may have an impact on pharmacotherapy and need to be addressed when pain therapists prescribe medication. Although pharmacogenetics as a diagnostic tool has the potential to improve patient therapy, well-designed studies are needed to demonstrate superiority to conventional dosing regimes.
Stamer
Ulrike M
UM
Department of Anaesthesiology & Intensive Care Medicine, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. ulrike.stamer@dkf.unibe.ch
Zhang
Lan
L
Stüber
Frank
F
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D002352:Carrier Proteins / Q000235:genetics; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D010597:Pharmacogenetics / Q000379:methods*; D057285:Precision Medicine / Q000379:methods*; D011957:Receptors, Opioid / Q000235:genetics
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000929:Antidepressive Agents, Tricyclic; D002352:Carrier Proteins; D011957:Receptors, Opioid; D003577:Cytochrome P-450 Enzyme System