Utilization of Pharmacogenomics and Therapeutic Drug Monitoring for Opioid Pain Management

Paul J Jannetto; Nancy C Bratanow


Pharmacogenomics. 2009;10(7):1157-1167. 

In This Article


It is estimated that almost half of all Americans have at least one family member who suffers from chronic pain due to a specific illness or medical condition.[41] An example is back pain,[42] which has a lifetime prevalence of 60-80% and results in significant physical, psychological and financial consequences.[43] In general, pain costs Americans more than US$100 billion each year in healthcare costs and lost productivity.[106]

Pharmacogenomics has the potential to allow clinicians and researchers to prescribe and design less toxic and more efficacious medications based on an individual's genotype. This study showed that the majority of individuals that experienced ADRs had impaired CYP2D6 metabolism. Furthermore, PMs and IMs generally had higher Css and TDM could potentially guide oxycodone therapy. As a result, personalized medical therapy for chronic pain patients based on their CYP2D6 genotype may predict which drug a patient may respond to without suffering any needless side effects and help them return to a normal, productive life. Personalized medicine for pain management offers the possibility of optimized pain control, with proper drug selection and dose determination, with increased patient safety and decreased risk of serious, potentially life-threatening side effects. Overall, this study illustrates that additional pain management studies investigating the role of pharmacogenomics and TDM need to be conducted using larger sample sizes to prove statistical significance.


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