Solving pain problems with genetic clues

Abstract

The patient was an intermediate metabolizer of cytochrome P450 (CYP)2D6, a pharmacogenetics test revealed. The patient’s reaction was the result of methadone’s CYP2D6 inhibition of duloxetine metabolism, thereby inadvertently creating an “overdose” of duloxetine in the patient. “Had I known the information beforehand, I would have been able to help avoid his readmission,” said Ernest Dole, PharmD, FASHP, BCPS, clinical pharmacist at the University of New Mexico Pain Consultation and Treatment Center in Albuquerque, NM. Simply defi ned, pharmacogenomics or pharmacogenetics—terms used interchangeably but with different meanings—refer to the study of how genetics or genes (genotype) infl uence a response to a medication therapy (phenotype) in a given population or in an individual patient, respectively. For the 30 million Americans who undergo surgical procedures each year and the 100 million patients who have chronic pain at some point in their lives, pain management is more than statistical odds and unusual outcomes. Pain is either controlled, or it’s not. And it’s a very personal experience.