Review

Personalized therapy in pain management: where do we stand?

† Author for correspondence

Email the corresponding author at ulrike.stamer@dkf.unibe.ch

Department of Anaesthesiology & Intensive Care Medicine, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany

Department of Anaesthesiology and Pain Therapy, Inselspital, University of Bern, Freiburgstr., CH-3010 Bern, Switzerland

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Frank Stüber

Department of Anaesthesiology and Pain Therapy, Inselspital, University of Bern, Freiburgstr., CH-3010 Bern, Switzerland

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Published Online:27 May 2010https://doi.org/10.2217/pgs.10.47

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Abstract

Genomic variations influencing response to pharmacotherapy of pain are currently under investigation. Drug-metabolizing enzymes represent a major target of ongoing research in order to identify associations between an individual’s drug response and genetic profile. Polymorphisms of the cytochrome P450 enzymes (CYP2D6) influence metabolism of codeine, tramadol, hydrocodone, oxycodone and tricyclic antidepressants. Blood concentrations of some NSAIDs depend on CYP2C9 and/or CYP2C8 activity. Genomic variants of these genes associate well with NSAIDs’ side effect profile. Other candidate genes, such as those encoding (opioid) receptors, transporters and other molecules important for pharmacotherapy in pain management, are discussed; however, study results are often equivocal. Besides genetic variants, further variables, for example, age, disease, comorbidity, concomitant medication, organ function as well as patients’ compliance, may have an impact on pharmacotherapy and need to be addressed when pain therapists prescribe medication. Although pharmacogenetics as a diagnostic tool has the potential to improve patient therapy, well-designed studies are needed to demonstrate superiority to conventional dosing regimes.

Keywords:

Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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Published online 27 May 2010

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The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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