Ineffective
pain control is the most commonly cited reason for misuse of prescription
opioids and is influenced by genetics. In particular, the gene encoding the
CYP2D6 enzyme, which metabolizes some of the most commonly prescribed
opioids (e.g.,
tramadol,
hydrocodone) to their more potent forms, is highly polymorphic and can lead to reduced concentrations of the active metabolites and decreased
opioid effectiveness. Consideration of the
CYP2D6 genotype may allow for predicting
opioid response and identifying patients who are likely to respond well to lower potency
opioids as well as those who may derive greater
pain relief from
non-opioid analgesics versus certain
opioids. There is emerging evidence that a CYP2D6-guided approach to
pain management improves
pain control and reduces
opioid consumption and thus may be a promising means for combating
opioid misuse. Clinical practice guidelines are available for select
opioids and other
analgesics to support medication and dose selection based on pharmacogenetic data. This article describes the evidence supporting genotype-guided
pain management as a means of improving
pain control and reducing
opioid misuse and clinical recommendations for genotype-guided
analgesic prescribing. In addition, a "how to" guide using patient case examples is provided to demystify the process for implementing pharmacogenetics-guided
pain management in order to optimize
analgesia and minimize adverse effects. Optimizing
pain management through genotype-guided approaches may ultimately provide safer and more effective
therapy for
pain control while decreasing the risk for
opioid misuse.