Abstract
Pain can have a significantly negative impact on the quality of life of patients. Therefore, patients may resort to analgesics to relieve the pain. The struggle to manage pain in cancer patients effectively and safely has long been an issue in medicine. Analgesics are the mainstay treatment for pain management as they act through various methods on the peripheral and central pain pathways. However, the variability in the patient genotypes may influence a drug response and adverse drug effects that follow through. This review summarizes the observed effects of analgesics on UDP-glucuronosyl (UGT) 2B7 isoenzyme, cytochrome P450 (CYP) 2D6, μ-opioid receptor μ 1 (OPRM1), efflux transporter P-glycoprotein (P-gp) and ATP-binding cassette B1 ABCB1/multiple drug resistance 1 (MDR1) polymorphisms on the mechanism of action of these drugs in managing pain in cancer. Furthermore, this review article also discusses the responses and adverse effects caused by analgesic drugs in cancer pain management, due to the inter-individual variability in their genomes.
Highlights
Pain is often experienced by cancer patients, those in the advanced stage of disease where the prevalence is estimated to be more than 70% [1]
A clinical study conducted by Kim and colleagues have demonstrated that patients who were administrated nefopam 48 hours post renal transplant operation consumed 19% less fentanyl compared to the control group
Pain management regimes are established to care for post-operative and palliative patients to improve their quality of life
Summary
Pain is often experienced by cancer patients, those in the advanced stage of disease where the prevalence is estimated to be more than 70% [1]. Some patients with advanced cancer have inadequate control of pain with systemic analgesics. Non-opioids, co-analgesics (e.g., nonsteroidal anti-inflammatory drugs), and non-pharmacological measures, are frequently used to enhance analgesic control and lessen opioid requirements. They are used to reduce adverse events related to opioid use [3]. A myriad of genes have been studied to identify biomarkers in opioid therapy These include genes implicated in the pharmacokinetics (CYP2D6, CYP3A4/5, ABCB1 and UGTs,) and pharmacodynamics (OPRM1 and COMT) of opioids [3]. These genes are studied vastly because they play a key role in drug metabolism.
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