title: A precision medicine approach to a patient with unresolved pain following orthopedic surgery: a case report.
abstract: BACKGROUND
  Precision medicine is a promising technology in patient care that combines genetic analysis with clinical data, such as health, behavioral, functional, environment, and lifestyle information. Here we present the case of a 54-year old woman who, following an accident, had uncontrolled chronic pain and was subsequently labeled a drug seeker.
  
  
  METHODS
  A 54-year-old white woman who was experiencing severe calf pain was referred for treatment. Her pain was insufficiently controlled immediately following knee arthroplasty with multiple opioid medications, as well as non-opioids. Precision medicine testing was ordered for her so that we could assess her pain sensitivity objectively to determine if the pill seeker designation was correct and to determine the best medications for her. Based on the Proove profiles, we determined that she had moderately low pain sensitivity, which means that clinically she may underreport pain and may have decreased medication needs. This result suggested that her continued reporting of unresolved pain was probably due to a condition unresolved by her right knee arthroplasty. In addition, she was found to be at low risk of opioid addiction, based on the Proove Opioid Risk Profile. Taken together, along with the high levels of pain she described, we determined that her pain was not properly controlled and that the designation of pill seeker was incorrect. The next step was to determine which medications and which doses would result in the most favorable outcomes for our patient. To determine this, we used the results of the Proove Opioid Response, Proove Drug Metabolism, and Proove Non-Opioid Profiles to guide her treatment. We reduced her pain medications to a single opioid, Vicodin (acetaminophen and hydrocodone), which also eliminated the adverse side effects she experienced.
  
  
  CONCLUSIONS
  Precision medicine offers an important health care decision tool which can reduce emotional and physical costs to patients and may reduce the economic health care burden of unnecessary surgeries and ineffective medication. The information provided by these profiles can be used clinically to guide treatment decisions and evaluate patient pain.
authors.affiliation: Newport Orthopedic Institute, Newport Beach, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gazzaniga
authors.affiliation: Proove Biosciences, 15326 Alton Pkwy, Irvine, CA, 92618, USA. abrenton@proove.com.
authors.forename: Ashley
authors.initials: A
authors.lastname: Brenton
authors.affiliation: Proove Biosciences, 15326 Alton Pkwy, Irvine, CA, 92618, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Meshkin
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee; D059350:Chronic Pain / Q000188:drug therapy* / Q000235:genetics; D003951:Diagnostic Errors; D058999:Drug-Seeking Behavior; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000235:genetics; D019338:Polypharmacy; D057285:Precision Medicine / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid
keywords: Opioid risk; Orthopedics; Pain management; Precision medicine; Predictive algorithms