title: Pain management in the 21st century: utilization of pharmacogenomics and therapeutic drug monitoring.
abstract: BACKGROUND
  Anesthesiologists and pain management physicians recognize that the key to clinical success is the ability to effectively control pain and related symptoms in patients without causing excess side effects from prescribed medications. The use of opioids for pain management is broadly accepted by regulatory bodies, professional organizations (i.e., the WHO) and physicians, as is the wide range of patient responses to these medications. Pharmacogenomics and therapeutic drug monitoring are two underutilized tools which can be implemented to best predict and monitor which opioid and dose may be the most appropriate for an individual patient.
  
  
  METHODS
  This review summarizes and discusses evidence for the use of genetic analysis to guide the selection and modification of opioid therapy along with the use of therapeutic drug monitoring to objectively check therapeutic outcomes and compliance. The reader will gain an understanding of the most notable genetic polymorphisms that can affect a patient's response to commonly prescribed opioids, along with the clinical benefits of genotyping and performing therapeutic drug monitoring.
  
  
  CONCLUSIONS
  In the end, the authors strongly believe that objective tools such as pharmacogenomics and therapeutic drug monitoring provide added benefit (minimizing adverse effects, while maximizing efficacy) and will ultimately advance the practice of pain management by incorporating these tools into the standard of care.
authors.affiliation: Medical College of Wisconsin, Pathology, Milwaukee, WI 53226, USA. jannetto@mcw.edu
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Jannetto
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Bratanow
mesh_terms: D000698:Analgesia / Q000379:methods* / Q000639:trends*; D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000627:therapeutic use; D002394:Catechol O-Methyltransferase / Q000378:metabolism; D016903:Drug Monitoring / Q000379:methods* / Q000639:trends*; D005838:Genotype; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000235:genetics; D010147:Pain Measurement / Q000379:methods; D010349:Patient Compliance; D010597:Pharmacogenetics / Q000379:methods* / Q000639:trends*; D011110:Polymorphism, Genetic; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D002394:Catechol O-Methyltransferase