title: CYP2D6 poor metabolizer genotype and smoking predict severe postoperative pain in female patients on arrival to the recovery room.
abstract: Recent studies have shown that CYP2D6 acts at critical steps for endogenous morphine biosynthesis. The present study assessed the contribution of CYP2D6 genetic polymorphisms, smoking, and other factors on acute severe postoperative pain (linear analog pain scores ≥8).
  
  
  METHODS
  Two hundred thirty-six female patients were found to have adequate information in a previously developed female surgical patient database to be included in this current analysis. Multiple logistic regression analysis was used to assess the predictors for acute severe postoperative pain. DNA had been previously extracted from blood samples in all patients and was genotyped by the Amplichip to determine the specific CYP2D6 genotypes.
  
  
  RESULTS
  It was noted that the incidence of acute severe postoperative pain (linear analog pain scores ≥8) was more frequent in patients with the CYP2D6 poor metabolizer (PM) genotype, 71%, compared with 28% in intermediate metabolizers (IMs), 26% in extensive metabolizers (EMs), and 27% in ultrarapid metabolizers (UMs). The overall association between metabolizer groups and severe postoperative pain was significant (P=0.023). PMs were significantly more likely to suffer from severe postoperative pain than IMs, EMs, and UMs (P=0.007, 0.002, and 0.050, respectively). There were no significant differences among IMs, EMs, and UMs. Additionally, it was noted that there was an increased frequency of acute severe postoperative pain in smokers vs nonsmokers (P=0.014).
  
  
  CONCLUSIONS
  This study demonstrated that female patients possessing the PM genotype of CYP2D6 and patients who smoke had a higher incidence of acute severe postoperative pain.
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, Florida 33101, USA.
authors.forename: Zongqi
authors.initials: Z
authors.lastname: Yang
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yang
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yiliam
authors.initials: Y
authors.lastname: Rodriguez
authors.forename: Chunyu
authors.initials: C
authors.lastname: Song
authors.forename: Melvin C
authors.initials: MC
authors.lastname: Gitlin
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D015897:Comorbidity / Q000639:trends; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics*; D005260:Female; D005544:Forecasting; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000235:genetics* / Q000378:metabolism; D011997:Recovery Room; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000235:genetics*; D055815:Young Adult
chemical_list: D019389:Cytochrome P-450 CYP2D6