How Pharmacogentic Testing Could Improve the Treatment of Chronic Pain

In addition to genetic variability, several other internal and external factors play a role in medication metabolism.

NATIONAL HARBOR, Md. – Completion of the Human Genome Project in 2003 has given researchers a complete view of the genetic blueprint of humans for the first time ever, and is leading to exciting advances in medicine that may results in more personalized and effective treatments for a variety of conditions.

“The future of health and medicine is growing exponentially faster, smarter, smaller, cheaper, and better by using technology,” said Anita Gupta, DO, PharmD, vice chair and associate professor of Anesthesiology and Perioperative Medicine at Drexel University in Philadelphia, during a keynote at the American Academy of Pain Management (AAPM)’s 2015 meeting.

She reviewed how pharmacogenetic testing to detect genetic variations called polymorphisms can influence individual responses to medication and may be able to improve the treatment of chronic pain.

“Polymorphisms can occur in the cytochrome oxidase P450 (CY450), which metabolize most medications,” said Dr. Gupta. “These changes in metabolism can lead to unexpected outcomes, such as lack of efficacy or increased or unexpected toxicity.”

Cytochrome oxidase P450 enzymes contain 57 different active genes and 17 different families.Key enzymes involved include CYP2D6, CYP2C19, CYP2BC, CYP2C9, CYP3A4 and CYP3A5, which regulate phase one metabolism of opioids including codeine, hydrocodone, oxycodone, methadone, and buprenorphine. Other enzymes called UDP glucuronosyltransferase, which include UGT2B7 and UGT2815, effect phase II metabolism of morphine, oyxmorphone, hydromorphone, and tapentadol.