1
|
Dwivedi I, Haddad GG. Investigating the neurobiology of maternal opioid use disorder and prenatal opioid exposure using brain organoid technology. Front Cell Neurosci 2024; 18:1403326. [PMID: 38812788 PMCID: PMC11133580 DOI: 10.3389/fncel.2024.1403326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024] Open
Abstract
Over the past two decades, Opioid Use Disorder (OUD) among pregnant women has become a major global public health concern. OUD has been characterized as a problematic pattern of opioid use despite adverse physical, psychological, behavioral, and or social consequences. Due to the relapsing-remitting nature of this disorder, pregnant mothers are chronically exposed to exogenous opioids, resulting in adverse neurological and neuropsychiatric outcomes. Collateral fetal exposure to opioids also precipitates severe neurodevelopmental and neurocognitive sequelae. At present, much of what is known regarding the neurobiological consequences of OUD and prenatal opioid exposure (POE) has been derived from preclinical studies in animal models and postnatal or postmortem investigations in humans. However, species-specific differences in brain development, variations in subject age/health/background, and disparities in sample collection or storage have complicated the interpretation of findings produced by these explorations. The ethical or logistical inaccessibility of human fetal brain tissue has also limited direct examinations of prenatal drug effects. To circumvent these confounding factors, recent groups have begun employing induced pluripotent stem cell (iPSC)-derived brain organoid technology, which provides access to key aspects of cellular and molecular brain development, structure, and function in vitro. In this review, we endeavor to encapsulate the advancements in brain organoid culture that have enabled scientists to model and dissect the neural underpinnings and effects of OUD and POE. We hope not only to emphasize the utility of brain organoids for investigating these conditions, but also to highlight opportunities for further technical and conceptual progress. Although the application of brain organoids to this critical field of research is still in its nascent stages, understanding the neurobiology of OUD and POE via this modality will provide critical insights for improving maternal and fetal outcomes.
Collapse
Affiliation(s)
- Ila Dwivedi
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Gabriel G. Haddad
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, United States
- Department of Neurosciences, School of Medicine, University of California, San Diego, La Jolla, CA, United States
- Rady Children’s Hospital, San Diego, CA, United States
| |
Collapse
|
2
|
Ferreira do Couto ML, Fonseca S, Pozza DH. Pharmacogenetic Approaches in Personalized Medicine for Postoperative Pain Management. Biomedicines 2024; 12:729. [PMID: 38672085 PMCID: PMC11048650 DOI: 10.3390/biomedicines12040729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Despite technical and pharmacological advancements in recent years, including optimized therapies and personalized medicine, postoperative pain management remains challenging and sometimes undertreated. This review aims to summarize and update how genotype-guided therapeutics within personalized medicine can enhance postoperative pain management. Several studies in the area have demonstrated that genotype-guided therapy has the ability to lower opioid consumption and improve postoperative pain. Gene mutations, primarily OPRM1, CYP2D6, CYP2C9, COMT and ABCB1, have been shown to exert nuanced influences on analgesic response and related pharmacological outcomes. This review underscores the integration of pharmacogenetic-guided personalized medicine into perioperative care, particularly when there is uncertainty regarding opioid prescriptions. This approach leads to superior outcomes in terms of postoperative pain relief and reduced morbidity for numerous patients.
Collapse
Affiliation(s)
- Maria Leonor Ferreira do Couto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
| | - Sara Fonseca
- Anesthesiology Department, São João University Hospital Centre, 4200-135 Porto, Portugal;
| | - Daniel Humberto Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
- Institute for Research and Innovation in Health and IBMC (i3S), University of Porto, 4200-135 Porto, Portugal
| |
Collapse
|
3
|
Haupt LM, Haywood A, Sutherland HG, Yu C, Albury CL, Pharasi A, Zunk M, George R, Griffiths LR, Good P, Hardy J. The effects of OPRM1 118A>G on methadone response in pain management in advanced cancer at end of life. Sci Rep 2024; 14:3411. [PMID: 38341456 PMCID: PMC10858860 DOI: 10.1038/s41598-024-54009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
Cancer pain is the most feared symptom at end of life. Methadone has advantages over other opioids but is associated with significant variability in clinical response, making dosing challenging in practice. OPRM1 is the most studied pharmacogene associated with the pharmacodynamics of opioids, however reports on the association of the A118G polymorphism on opioid dose requirements are conflicting, with no reports including methadone as the primary intervention. This association study on OPRM1 A118G and response to methadone for pain management, includes a review of this genetic factor's role in inter-patient variability. Fifty-four adult patients with advanced cancer were recruited in a prospective, multi-centre, open label dose individualization study. Patient characteristics were not shown to influence methadone response, and no significant associations were observed for methadone dose or pain score. The findings of our review of association studies for OPRM1 A118G in advanced cancer pain demonstrate the importance of taking ancestry into account. While our sample size was small, our results were consistent with European populations, but in contrast to studies in Chinese patients, where carriers of the A118G polymorphism were associated with higher opioid dose requirements. Pharmacogenetic studies in palliative care are challenging, continued contribution will support future genotype-based drug dosing guidelines.
Collapse
Affiliation(s)
- Larisa M Haupt
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.
- ARC Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology (QUT), Brisbane, Australia.
- Max Planck Queensland Centre for the Materials Sciences of Extracellular Matrices, Brisbane, Australia.
| | - Alison Haywood
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia.
- Mater Research Institute-The University of Queensland, Brisbane, Australia.
| | - Heidi G Sutherland
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Chieh Yu
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
- Department of Cell and Tissue Biology, University of California, San Francisco, USA
| | - Cassie L Albury
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Anushka Pharasi
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Mathew Zunk
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Rani George
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
- Cancer Trials Unit, Division of Cancer Services, Metro South Health, Brisbane, Australia
| | - Lyn R Griffiths
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Phillip Good
- Mater Research Institute-The University of Queensland, Brisbane, Australia
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Australia
| | - Janet Hardy
- Mater Research Institute-The University of Queensland, Brisbane, Australia
- Department of Palliative and Supportive Care, Mater Health, Brisbane, Australia
| |
Collapse
|
4
|
Conradt E, Camerota M, Maylott S, Lester BM. Annual Research Review: Prenatal opioid exposure - a two-generation approach to conceptualizing neurodevelopmental outcomes. J Child Psychol Psychiatry 2023; 64:566-578. [PMID: 36751734 DOI: 10.1111/jcpp.13761] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
Opioid use during pregnancy impacts the health and well-being of two generations: the pregnant person and the child. The factors that increase risk for opioid use in the adult, as well as those that perpetuate risk for the caregiver and child, oftentimes replicate across generations and may be more likely to affect child neurodevelopment than the opioid exposure itself. In this article, we review the prenatal opioid exposure literature with the perspective that this is not a singular event but an intergenerational cascade of events. We highlight several mechanisms of transmission across generations: biological factors, including genetics and epigenetics and the gut-brain axis; parent-child mechanisms, such as prepregnancy experience of child maltreatment, quality of parenting, infant behaviors, neonatal opioid withdrawal diagnosis, and broader environmental contributors including poverty, violence exposure, stigma, and Child Protective Services involvement. We conclude by describing ways in which intergenerational transmission can be disrupted by early intervention.
Collapse
Affiliation(s)
- Elisabeth Conradt
- Department of Psychiatry, Duke University, Durham, NC, USA.,Department of Pediatrics, Duke University, Durham, NC, USA
| | - Marie Camerota
- Brown Center for the Study of Children at Risk, Department of Psychiatry and Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - Sarah Maylott
- Department of Psychiatry, Duke University, Durham, NC, USA
| | - Barry M Lester
- Brown Center for the Study of Children at Risk, Department of Psychiatry and Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island, Providence, RI, USA
| |
Collapse
|
5
|
Satkunananthan SE, Suppiah V, Toh GT, Yow HY. Pharmacogenomics of Cancer Pain Treatment Outcomes in Asian Populations: A Review. J Pers Med 2022; 12:1927. [PMID: 36422103 PMCID: PMC9694298 DOI: 10.3390/jpm12111927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 08/26/2023] Open
Abstract
In advanced cancer, pain is a poor prognostic factor, significantly impacting patients' quality of life. It has been shown that up to 30% of cancer patients in Southeast Asian countries may receive inadequate analgesia from opioid therapy. This significant under-management of cancer pain is largely due to the inter-individual variability in opioid dosage and relative efficacy of available opioids, leading to unpredictable clinical responses to opioid treatment. Single nucleotide polymorphisms (SNPs) cause the variability in opioid treatment outcomes, yet their association in Asian populations remains unclear. Therefore, this review aimed to evaluate the association of SNPs with variability in opioid treatment responses in Asian populations. A literature search was conducted in Medline and Embase databases and included primary studies investigating the association of SNPs in opioid treatment outcomes, namely pharmacokinetics, opioid dose requirements, and pain control among Asian cancer patients. The results show that CYP2D6*10 has the most clinical relevance in tramadol treatment. Other SNPs such as rs7439366 (UGT2B7), rs1641025 (ABAT) and rs1718125 (P2RX7) though significant have limited pharmacogenetic implications due to insufficient evidence. OPRM1 rs1799971, COMT rs4680 and ABCB1 (rs1045642, rs1128503, and rs2032582) need to be further explored in future for relevance in Asian populations.
Collapse
Affiliation(s)
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Gaik-Theng Toh
- School of Medicine, Faculty of Health and Medical Sciences, Centre for Drug Discovery and Molecular Pharmacology, Taylor’s University, Subang Jaya 47500, Malaysia
| | - Hui-Yin Yow
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| |
Collapse
|
6
|
Yang Y, Guan B, Wei Q, Wang W, Meng A. Morphine analgesia in male inbred genetic diversity mice recapitulates the among-individual variance in response to morphine in humans. Animal Model Exp Med 2022; 5:288-296. [PMID: 35656737 PMCID: PMC9240740 DOI: 10.1002/ame2.12234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/03/2022] [Indexed: 12/01/2022] Open
Abstract
Morphine is a widely used analgesic, but its use in clinical precision medicine is limited by the variance in response among individuals. Although previous studies have shown that individual differences in morphine can be explained in terms of pharmacodynamics and pharmacokinetics, genetic polymorphisms also play an important role. However, the genetic basis of different sensitivity and tolerance susceptibility to morphine remains ambiguous. Using 15 strains of inbred Genetic Diversity (GD) mice, a new resource with wide genetic and phenotypic variation, we demonstrated great variance in sensitivity to morphine analgesia and susceptibility to morphine tolerance between different GD strains. Among-individual variance in response to morphine analgesia in the population can be modeled in GD mice. Two loci respectively may be associated with the among-individual variance in morphine sensitivity and tolerance, confirming the role of genetic factors in among-individual different responses to morphine. These results indicate that GD mice may be a potential tool for the identification of new biomarkers to improve the clinical administration of morphine.
Collapse
Affiliation(s)
- Yin Yang
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Engineering Research Center for Laboratory Animal Models of Human Critical Diseases, Institute of Laboratory Animal SciencesChinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC)BeijingChina
- Department of Physiology and Neurobiology, School of Basic Medical SciencesZhengzhou UniversityZhengzhouChina
| | - Bowen Guan
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Engineering Research Center for Laboratory Animal Models of Human Critical Diseases, Institute of Laboratory Animal SciencesChinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC)BeijingChina
| | - Qiang Wei
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Engineering Research Center for Laboratory Animal Models of Human Critical Diseases, Institute of Laboratory Animal SciencesChinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC)BeijingChina
| | - Wei Wang
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Engineering Research Center for Laboratory Animal Models of Human Critical Diseases, Institute of Laboratory Animal SciencesChinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC)BeijingChina
| | - Aimin Meng
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Engineering Research Center for Laboratory Animal Models of Human Critical Diseases, Institute of Laboratory Animal SciencesChinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC)BeijingChina
| |
Collapse
|
7
|
Hamilton WG, Gargiulo JM, Reynolds TR, Parks NL. Prospective Randomized Study Using Pharmacogenetics to Customize Postoperative Pain Medication Following Hip and Knee Arthroplasty. J Arthroplasty 2022; 37:S76-S81. [PMID: 35279338 DOI: 10.1016/j.arth.2022.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to determine whether pharmacogenetic testing could be used to effectively customize postoperative pain medicine following total joint replacement. METHODS Buccal swabs were collected preoperatively from 107 patients. Pharmacogenetic testing was performed for genetic variants on a panel of 16 genes, including CYP2D6, CYP2C9, OPRM1, and CYP1A2, which affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and many opioids. Patients were randomized to a control group or custom group and blinded to their group. The control group was prescribed oxycodone, tramadol, and celecoxib for postoperative pain management. If any of those were not normally metabolized, they were not prescribed to the patients in the custom group, who were given an alternative drug (hydromorphone for narcotics, meloxicam for non-steroidal anti-inflammatory drugs). Patients recorded their pain level (0-10 numeric scale) and all medications taken daily for the first 10 days following surgery. Medication was converted to milligram morphine equivalents (MMEs). RESULTS Genetic variations to medications in our standard postoperative pain management protocol occurred in 24 of the 107 patients (22.4%). The 10-day MME consumed by patients in the control group with genetic variants was 162.6 mg. Patients with variants who had custom postoperative medication consumed only 86.7 MME in the same timeframe (P = .126). The control group demonstrated a higher 10-day average pain level of 4.2 vs the custom group pain level of only 3.1 (P < .05). CONCLUSION With custom postoperative pain prescriptions based on pharmacogenetic testing, patients were able to achieve lower pain levels while reducing the consumption of pain medication.
Collapse
Affiliation(s)
| | | | | | - Nancy L Parks
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| |
Collapse
|
8
|
Lopes GS, Lopes JL, Bielinski SJ, Armasu SM, Zhu Y, Cavanaugh DC, Moyer AM, Jacobson DJ, Wang L, Jiang R, St. Sauver JL, Larson NB. Identification of sex-specific genetic associations in response to opioid analgesics in a White, non-Hispanic cohort from Southeast Minnesota. THE PHARMACOGENOMICS JOURNAL 2022; 22:117-123. [PMID: 35102242 PMCID: PMC8975736 DOI: 10.1038/s41397-022-00265-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
The study of sex-specific genetic associations with opioid response may improve the understanding of inter-individual variability in pain treatments. We investigated sex-specific associations between genetic variation and opioid response. We identified participants in the RIGHT Study prescribed codeine, tramadol, hydrocodone, and oxycodone between 01/01/2005 and 12/31/2017. Prescriptions were collapsed into codeine/tramadol and hydrocodone/oxycodone. Outcomes included poor pain control and adverse reactions within six weeks after prescription date. We performed gene-level and single-variant association analyses stratified by sex. We included 7169 non-Hispanic white participants and a total of 1940 common and low-frequency variants (MAF > 0.01). Common variants in MACROD2 (rs76026520), CYP1B1 (rs1056837, rs1056836), and CYP2D6 (rs35742686) were associated with outcomes. At the gene level, FAAH, SCN1A, and TYMS had associations for men and women, and NAT2, CYP3A4, CYP1A2, and SLC22A2 had associations for men only. Our findings highlight the importance of considering sex in association studies on opioid response.
Collapse
|
9
|
Genetic and Clinical Factors Associated with Opioid Response in Chinese Han Patients with Cancer Pain: An Exploratory Cross-Sectional Study. Pain Ther 2022; 11:269-288. [PMID: 35107781 PMCID: PMC8861215 DOI: 10.1007/s40122-022-00353-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction Studies have shown that genetic variation and environmental factors are associated with individual differences in therapeutic efficacy and side effects of opioids. However, the focus of these studies has been on a single factor of single-nucleotide polymorphisms (SNPs) or haplotypes, for which results have rarely been validated. For complex traits, such as cancer pain and opioid response, interactions between multiple genetic variation and environmental factors need to be considered to explain the opioid individual differences. Methods We conducted an exploratory two-stage cross-sectional study with 1027 Chinese patients who were taking strong opioid medications for their cancer pain, and genotyped 110 SNPs to explore the association of SNPs, haplotypes, gene–gene and gene–environment interactions with opioid dose, pain relief, and opioid-induced constipation. Results Due to the failure to meet Benjamini–Hochberg criteria in the discovery stage or to be validated in replication stage, no association was found between SNPs, haplotypes, paired SNP–SNP interactions or multi-dimensional gene–gene interactions and opioid response. However, for gene–environment interactions, optimal models have been constructed in all phenotypes of opioid response. Conclusions This study reveals for the first time that construction of multidimensional gene–environment interactions enables better interpretations of the effect of genetic variation and environmental factors on the opioid response in patients with cancer pain. Trial registration Chictr.org.cn, identifier, ChiCTR2000033576. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00353-5.
Collapse
|
10
|
Howes S, Cloutet AR, Kweon J, Powell TL, Raza D, Cornett EM, Kaye AD. Pharmacogenomics of Opioid Treatment for Pain Management. Methods Mol Biol 2022; 2547:491-504. [PMID: 36068474 DOI: 10.1007/978-1-0716-2573-6_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pain affects approximately 100 million Americans. Pain harms quality of life and costs patients billions of dollars per year. Clinically, nonpharmacologic and pharmacologic therapies can alleviate acute and chronic pain suffering. Opioids are one type of medication used to manage pain. However, opioids can potentially create dependence and substance abuse, and the effects are not consistent in all patients. Pharmacogenomics is the study of the genome to understand the effects of drugs on individual patients based on their genetic information. Through pharmacogenomics, researchers can investigate genetic polymorphisms related to pain that maximize individual patient drug responses and minimize toxicity. This chapter discusses the pharmacogenomics of opioids to treat pain, including individual genetic differences to opioid treatments, opioid pharmacokinetics and pharmacodynamics, and the genetic polymorphisms associated with individual opioid medications.
Collapse
Affiliation(s)
| | | | | | | | - Daniel Raza
- Tulane School of Medicine, New Orleans, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, LSU Health Shreveport, Shreveport, LA, USA
| |
Collapse
|
11
|
Leduc-Pessah H, Trang T. Tackling the opioid crisis: Novel mechanisms and clinical perspectives. J Neurosci Res 2021; 100:5-9. [PMID: 34672010 DOI: 10.1002/jnr.24964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Heather Leduc-Pessah
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada.,Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tuan Trang
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada.,Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
12
|
A functional polymorphism in the ATP-Binding Cassette B1 transporter predicts pharmacologic response to combination of nortriptyline and morphine in neuropathic pain patients. Pain 2021; 161:619-629. [PMID: 31738228 DOI: 10.1097/j.pain.0000000000001750] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many genetic markers have been associated with variations in treatment response to analgesics, but none have been assessed in the context of combination therapies. In this study, the treatment effects of nortriptyline and morphine were tested for an association with genetic markers relevant to pain pathways. Treatment effects were determined for single and combination therapies. A total of 24 functional single nucleotide polymorphisms were tested within the gene loci of mu-opioid receptor (OPRM1) gene locus, ATP-Binding Cassette B1 Transporter (ABCB1), Cytochrome P450 gene family (CYP2C19 and CYP2D6), catecholamine inactivator Catechol-O-Methyl Transferase (COMT), and serotonin receptor 2A (HTR2A). Genotyping was performed in a population of neuropathic pain patients who previously participated in a clinical trial. For monotherapy, neither nortriptyline nor morphine responses were associated with single nucleotide polymorphisms. However, for nortriptyline + morphine combination therapy, the single nucleotide polymorphism rs1045642 within the drug efflux pump ABCB1 transporter significantly predicted analgesic response. The presence of the C allele accounted for 51% of pain variance in this subgroup in response to combination treatment. The T-allele homozygotes demonstrated only 20% improvement in pain scores, whereas the C-allele homozygotes 88%. There was no significant contribution of rs1045642 to the medication side effects under all treatment conditions. The UK Biobank data set was then used to validate this genetic association. Here, patients receiving similar combination therapy (opioid + tricyclic antidepressant) carrying the C allele of rs1045642 displayed 33% fewer body pain sites than patients without that allele, suggesting better pain control. In all, our results show a robust effect of the rs1045642 polymorphism in response to chronic pain treatment with a nortriptyline + morphine combination.
Collapse
|
13
|
Dafniet B, Cerisier N, Audouze K, Taboureau O. Drug-target-ADR Network and Possible Implications of Structural Variants in Adverse Events. Mol Inform 2020; 39:e2000116. [PMID: 32725965 PMCID: PMC8047896 DOI: 10.1002/minf.202000116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
Abstract
Adverse drug reactions (ADRs) are of major concern in drug safety. However, due to the biological complexity of human systems, understanding the underlying mechanisms involved in development of ADRs remains a challenging task. Here, we applied network sciences to analyze a tripartite network between 1000 drugs, 1407 targets, and 6164 ADRs. It allowed us to suggest drug targets susceptible to be associated to ADRs and organs, based on the system organ class (SOC). Furthermore, a score was developed to determine the contribution of a set of proteins to ADRs. Finally, we identified proteins that might increase the susceptibility of genes to ADRs, on the basis of knowledge about genomic structural variation in genes encoding proteins targeted by drugs. Such analysis should pave the way to individualize drug therapy and precision medicine.
Collapse
Affiliation(s)
- Bryan Dafniet
- Université de ParisINSERM U1133, CNRS UMR 825175006ParisFrance
| | | | - Karine Audouze
- Université de ParisT3S, INSERM UMR S-112475006ParisFrance
| | | |
Collapse
|
14
|
Kaye AD, Koress CM, Novitch MB, Jung JW, Urits I, Viswanath O, Renschler JS, Alpaugh ES, Cornett EM. Pharmacogenomics, concepts for the future of perioperative medicine and pain management: A review. Best Pract Res Clin Anaesthesiol 2020; 34:651-662. [PMID: 33004174 DOI: 10.1016/j.bpa.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023]
Abstract
Pharmacogenomics is the study of how genetic differences between individuals affect pharmacokinetics and pharmacodynamics. These differences are apparent to clinicians when taking into account the wide range of responses to medications given in clinical practice. A review of literature involving pharmacogenomics and pain management was performed. The implementation of preoperative pharmacogenomics will allow us to better care for our patients by delivering personalized, safer medicine. This review describes the current state of pharmacogenomics as it relates to many aspects of clinical practice and how clinicians can use these tools to improve patient outcomes.
Collapse
Affiliation(s)
- Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA.
| | - Cody M Koress
- Tulane University School of Medicine, Department of Internal Medicine, New Orleans, LA, USA.
| | - Matthew B Novitch
- University of Washington, Department of Anesthesiology, Seattle, WA, USA; Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, USA.
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA.
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Omar Viswanath
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology Phoenix, AZ, USA.
| | | | - Edward S Alpaugh
- Louisiana State University Health Sciences Center, Department of Anesthesiology, Orleans, LA, USA.
| | - Elyse M Cornett
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA.
| |
Collapse
|
15
|
Ho KWD, Wallace MR, Staud R, Fillingim RB. OPRM1, OPRK1, and COMT genetic polymorphisms associated with opioid effects on experimental pain: a randomized, double-blind, placebo-controlled study. THE PHARMACOGENOMICS JOURNAL 2020; 20:471-481. [PMID: 31806881 PMCID: PMC7260086 DOI: 10.1038/s41397-019-0131-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 01/13/2023]
Abstract
Genetic polymorphisms have been shown to affect opioid requirement for pain relief. However, true genetic effect is often difficult to assess due to underlying pain conditions and placebo effects. The goal of this study was to understand how common polymorphisms affect opioid effects while controlling for these factors. A randomized, double-blind, placebo-controlled study was implemented to assess how opioid effects are modulated by COMT (rs6269, rs4633, rs4848, rs4680), OPRM1 (A118G), and OPRK1 (rs1051660, rs702764, rs16918875). One hundred and eight healthy subjects underwent experimental pain testing before and after morphine, butorphanol, and placebo (saline). Association analysis was performed between polymorphisms/haplotypes and opioid response, while correcting for race, gender, placebo effects, and multiple comparisons. Pressure pain was significantly associated with rs6269 and rs4633 following butorphanol. The AA genotype of rs4680 or A_T_C_A/ A_T_C_A (rs6269_rs4633_ rs4818_rs4680) diplotype of COMT, combined with the AG genotype of OPRM1 A118G, showed significantly increased pressure pain threshold from butorphanol. Opioid effects on pressure, ischemic, heat pain, and side effects were nominally associated with several SNPs and haplotypes. Effects were often present in one opioid but not the other. This indicates that these polymorphisms affect pain relief from opioids, and that their effects are opioid and pain modality specific.
Collapse
Affiliation(s)
- Kwo Wei David Ho
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University, Redwood City, CA, USA.
- Department of Neurology, University of Florida, Gainesville, FL, USA.
| | - Margaret R Wallace
- Department of Molecular Genetics & Microbiology, and UF Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| |
Collapse
|
16
|
Gudin J, Mavroudi S, Korfiati A, Theofilatos K, Dietze D, Hurwitz P. Reducing Opioid Prescriptions by Identifying Responders on Topical Analgesic Treatment Using an Individualized Medicine and Predictive Analytics Approach. J Pain Res 2020; 13:1255-1266. [PMID: 32547186 PMCID: PMC7266406 DOI: 10.2147/jpr.s246503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Chronic pain is a life changing condition, and non-opioid treatments have been lately introduced to overcome the addictive nature of opioid therapies and their side effects. In the present study, we explore the potential of machine learning methods to discriminate chronic pain patients into ones who will benefit from such a treatment and ones who will not, aiming to personalize their treatment. PATIENTS AND METHODS In the current study, data from the OPERA study were used, with 631 chronic pain patients answering the Brief Pain Inventory (BPI) validated questionnaire along with supplemental questions before and after a follow-up period. A novel machine learning approach combining multi-objective optimization and support vector regression was used to build prediction models which can predict, using responses in the baseline, the four different outcomes of the study: total drugs change, total interference change, total severity change, and total complaints change. Data were split to training (504 patients) and testing (127 patients) sets and all results are measured on the independent test set. RESULTS The machine learning models extracted in the present study significantly overcame other state of the art machine learning methods which were deployed for comparative purposes. The experimental results indicated that the machine learning models can predict the outcomes of this study with considerably high accuracy (AUC 73.8-87.2%) and this allowed their incorporation in a decision support system for the selection of the treatment of chronic pain patients. CONCLUSION Results of this study revealed the potential of machine learning for an individualized medicine application for chronic pain therapies. Topical analgesics treatment were proven to be, in general, beneficial but carefully selecting with the suggested individualized medicine decision support system was able to decrease by approximately 10% the patients which would have been subscribed with topical analgesics without having benefits from it.
Collapse
Affiliation(s)
| | - Seferina Mavroudi
- Department of Nursing, School of Health Rehabilitation Sciences, University of Patras, Pátrai, Greece
- InSyBio Ltd, Winchester, UK
| | | | | | - Derek Dietze
- Metrics for Learning LLC, Queen Creek, Arizona, USA
| | - Peter Hurwitz
- Clarity Science LLC, Narragansett, Rhode Island, USA
| |
Collapse
|
17
|
Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
Collapse
|
18
|
Nissen SK, Pottegård A, Ryg J. Trends of Opioid Utilisation in Denmark: A Nationwide Study. Drugs Real World Outcomes 2019; 6:155-164. [PMID: 31535353 PMCID: PMC6879688 DOI: 10.1007/s40801-019-00163-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Opioid use has more than doubled over recent decades, and Denmark occupies fifth place in the global ranking. These increases have been partly attributed to the ageing population. Objective Our objective was to assess the impact of age over time on utilisation of the most commonly used opioids in Denmark. Methods We retrieved nationwide sales data on opioid sales in Denmark from 1999 to 2017. We investigated utilisation trends in age groups for the four opioids with the highest use. We used three volume-based metrics (defined daily doses/1000/day, oral morphine equivalents/1000/day, and packages dispensed/year) and one person-based metric (users/1000/year). Results The four opioids selected according to users/1000/year were tramadol (46.1), codeine and combination products (12.4 for codeine, 3.7 for codeine and acetylsalicylic acid, and 4.2 for codeine and paracetamol), morphine (17.0), and oxycodone (12.1). Overall utilisation according to volume and person metrics increased for all except codeine and combination products. Tramadol doses or strength increased, albeit less with increasing age. Oxycodone doses or strength decreased for all age groups but were nearly unchanged for the age group ≥ 80 years. Conclusion Tramadol is the most utilised opioid in Denmark and was prescribed at increasing doses or strengths over the study period, particularly in the younger (< 80 years) age groups. Overall, oxycodone was prescribed at decreasing doses or strengths over time but remained unchanged for the age group ≥ 80 years. There is a need to address the pharmacological treatment of pain in terms of age, with tramadol and oxycodone being possible targets for regulatory efforts. Electronic supplementary material The online version of this article (10.1007/s40801-019-00163-w) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Søren Kabell Nissen
- Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense C, Denmark.
| | - Anton Pottegård
- Department of Public Health, University of Southern Denmark, Clinical Pharmacology and Pharmacy, J. B. Winsløwsvej 19, 3, 5000, Odense C, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J. B. Winsløwsvej 19, 3, 5000, Odense C, Denmark
| |
Collapse
|
19
|
Kaye AD, Garcia AJ, Hall OM, Jeha GM, Cramer KD, Granier AL, Kallurkar A, Cornett EM, Urman RD. Update on the pharmacogenomics of pain management. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:125-143. [PMID: 31308726 PMCID: PMC6613192 DOI: 10.2147/pgpm.s179152] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/09/2019] [Indexed: 12/30/2022]
Abstract
Pharmacogenomics is the study of genetic variants that impact drug effects through changes in a drug’s pharmacokinetics and pharmacodynamics. Pharmacogenomics is being integrated into clinical pain management practice because variants in individual genes can be predictive of how a patient may respond to a drug treatment. Pain is subjective and is considered challenging to treat. Furthermore, pain patients do not respond to treatments in the same way, which makes it hard to issue a consistent treatment regimen for all pain conditions. Pharmacogenomics would bring consistency to the subjective nature of pain and could revolutionize the field of pain management by providing personalized medical care tailored to each patient based on their gene variants. Additionally, pharmacogenomics offers a solution to the opioid crisis by identifying potentially opioid-vulnerable patients who could be recommended a nonopioid treatment for their pain condition. The integration of pharmacogenomics into clinical practice creates better and safer healthcare practices for patients. In this article, we provide a comprehensive history of pharmacogenomics and pain management, and focus on up to date information on the pharmacogenomics of pain management, describing genes involved in pain, genes that may reduce or guard against pain and discuss specific pain management drugs and their genetic correlations.
Collapse
Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology, LSU Health Sciences Center, New Orleans, LA, USA
| | - Andrew Jesse Garcia
- Department of Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - O Morgan Hall
- Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - George M Jeha
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Kelsey D Cramer
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Amanda L Granier
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Anusha Kallurkar
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
20
|
Aroke EN, Hicks TL. Pharmacogenetics of Postoperative Nausea and Vomiting. J Perianesth Nurs 2019; 34:1088-1105. [PMID: 31227296 DOI: 10.1016/j.jopan.2019.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 12/17/2022]
Abstract
Postoperative nausea and vomiting (PONV) remains one of the most common adverse effects of anesthesia, affecting up to 80% of high-risk patients within 24 hours after surgery. Patient-related factors, surgical procedure, and perioperative medications such as opioids determine a patient's risk for PONV. To prevent and manage PONV, ondansetron, a 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, is frequently administered. Ondansetron is metabolized predominantly by hepatic cytochrome P450 (CYP2D6) enzymes, encoded by the CYP2D6 gene, whereas most of the effects of opioids are exerted at the opioid mu-1 receptor, encoded by the OPRM1 gene. Genetic polymorphisms of the CYP2D6 and OPRM1 genes may have a role in interindividual variation in the occurrence of PONV. Specifically, the occurrence of the G-allele produced by the OPRM1 A118G appears to be protective against PONV, whereas CYP2D6 ultrarapid metabolism increases the risk for PONV. The Clinical Pharmacogenetics Implementation Consortium guidelines provide CYP2D6-guided therapeutic recommendations for ondansetron. However, further studies are needed to investigate the role of genetic polymorphism in the occurrence of PONV and response to antiemetics.
Collapse
|
21
|
Yan Q, Su Y, Gao L, Ding N, Zhang HY, E W, Wang Y, Feng Y, An HY. Impact of CYP3A4*1G Polymorphism on Fentanyl Analgesia Assessed by Analgesia Nociception Index in Chinese Patients Undergoing Hysteroscopy. Chin Med J (Engl) 2019; 131:2693-2698. [PMID: 30381583 PMCID: PMC6247602 DOI: 10.4103/0366-6999.243934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The clinical efficacy of fentanyl for pain control differs greatly across individuals. The purpose of this study was to investigate the impact of CYP3A4*1G polymorphism including wild-type homozygote (CYP3A4*1/*1, GG), mutant heterozygote (CYP3A4*1/*1G, GA), and mutant homozygote (CYP3A4*1G/*1G, AA) on fentanyl analgesia in Chinese patients undergoing hysteroscopy by the assessment of analgesia nociception index (ANI). Methods: A total of 200 gynecologic patients scheduled for elective hysteroscopy under general anesthesia at Peking University People's Hospital from May to December in 2017 were enrolled in this study. Venous blood was withdrawn for genotyping of CYP3A4*1G before operation. Fentanyl 1 μg/kg was administered preoperatively followed by target-controlled infusion of propofol for induction and maintenance. Intraoperative analgesic efficacy of fentanyl was assessed by ANI monitoring at T0 (entering room), T1 (cervical dilation), T2 (start of cervical aspiration), and T3 (end of cervical aspiration) time points. The duration of propofol infusion and total dosage of propofol were recorded as well. Results: The patients were divided into three groups according to CYP3A4*1G polymorphism, including 143 in GG group, 47 in GA group, and 10 in AA group. There was no significant difference in clinical demographics among three groups. The frequency of CYP3A4*1G variant alleles accounted for 16.8% and the distribution of variant alleles was consistent with Hardy–Weinberg equilibrium. Using a multilevel model, ANI values at T1 (63.81 ± 19.61), T2 (63.63 ± 17.82), and T3 (65.68 ± 17.79) were significantly lower than that at T0 (77.16 ± 12.93) in the study population (F = 23.50, P < 0.001), suggesting that higher levels of pain at T1, T2, and T3 than T0. Patients with GG genotype showed significantly lower ANI than those with GA or AA genotypes during hysteroscopy under the same dose of fentanyl. Conclusion: CYP3A4*1G polymorphism associated with the analgesic efficacy of intraoperative fentanyl in the patients undergoing hysteroscopy under general anesthesia.
Collapse
Affiliation(s)
- Qi Yan
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| | - Yi Su
- Department of Anesthesiology, Jincheng Maternal and Child Health Care Hospital, Jincheng, Shanxi 048000, China
| | - Lan Gao
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| | - Nan Ding
- Department of Pathology, Peking University Health Science Center, Beijing 100191, China
| | - Hong-Ying Zhang
- Department of Pathology, Peking University Health Science Center, Beijing 100191, China
| | - Wen E
- Department of Pathology, Peking University Health Science Center, Beijing 100191, China
| | - Yue Wang
- Department of Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| | - Hai-Yan An
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| |
Collapse
|
22
|
Abstract
INTRODUCTION Opioids are widely used after orthopaedic procedures. Nonmedical opioid use is a growing public health issue. METHODS An anonymous online survey was distributed by e-mail to the orthopaedic societies of all 50 states and several large private practices to assess practicing orthopaedic surgeons' opioid prescribing practices. RESULTS A total of 555 orthopaedic surgeons practicing in 37 states responded. The most commonly prescribed opioid for both teenagers and adults was hydrocodone/acetaminophen. Of note, 42.3% reported that a patient they have prescribed opioids for developed an opioid dependency, whereas 35.3% do not believe that opioid use is a problem in their practice. Of note, 30.3% reported prescribing refills, and factors significantly associated with increased prescribing of refills included a greater number of years in practice (P < 0.001) and practicing in a suburban rather than an urban or rural environment (P = 0.03). CONCLUSION Orthopaedic surgeons rarely prescribe any refills, tend to prescribe less opioids to teenagers than adults, and prescribe fairly uniformly for patients who are treated nonsurgically or undergo minor or arthroscopic surgery. They exhibit considerable variation in prescribing for fractures and major procedures.
Collapse
|
23
|
Vieira CMP, Fragoso RM, Pereira D, Medeiros R. Pain polymorphisms and opioids: An evidence based review. Mol Med Rep 2018; 19:1423-1434. [PMID: 30592275 PMCID: PMC6390004 DOI: 10.3892/mmr.2018.9792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022] Open
Abstract
Despite the various different candidate genetic polymorphisms of potential clinical relevance, there is not enough understanding of the inter-individual variability in analgesic administration. The cytochrome P450 2D6 (CYP2D6) genotype is thought to be one of the most studied. The aim of the present evidence-based review was to determine if there is now sufficient evidence to make clinical recommendations based on a specific genomic profile. The data sources utilized were as follows: PubMed (NLM) database, Evidence Based Medicine Guidelines and Google. Research on clinical guidance standards, systematic reviews, meta-analyses and clinical trials, published prior to January 2018, were evaluated in English, using the MeSH terms ‘cancer pain’, ‘polymorphism’, ‘genetic’ and ‘gene polymorphism’. To assess the level of evidence, the Strength of Recommendation Taxonomy of the American Family Physician was applied. From the initial search, 12 systematic reviews and/or meta-analyses, 5 clinical trials and 10 guidelines were selected. The results indicated that genetic variation of µ-opioid receptor 1 (OPRM1) may contribute to inter-individual differences in morphine consumption with recommendation grade A for OPRM A118G single nucleotide polymorphism (rs1799971). Polymorphisms associated with the metabolization process of morphine and other opioid drugs are very relevant in opioid titration and ethnic subgroup differences which have to be taken into account (particularly, for the recommendation grade A for the CYP2D6 polymorphism). In human studies, the catechol-O-methyl transferase (COMT) genotype affects the efficacy of opioids in acute and chronic pain under different settings, with recommendation grade B to the COMT single nucleotide polymorphism rs4680 (Val/Met). Finally, polymorphisms of the ATP-binding cassette family of efflux transporters were highlighted. Consistent data on pain polymorphisms is now widely available; however, these results have had very little impact on clinical guidelines and daily oncologist practice. Persisting pain, side effects of grade 3 (NCI-CTCAE v4.0) and breakthrough pain with more than 4 episodes/day should be considered the criteria for pain multidisciplinary team discussions and for polymorphism screening.
Collapse
Affiliation(s)
| | - Rosa Maria Fragoso
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO‑PORTO), 4200‑072 Porto, Portugal
| | - Deolinda Pereira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO‑PORTO), 4200‑072 Porto, Portugal
| | - Rui Medeiros
- Research Centre‑Molecular Oncology Group, Instituto Português de Oncologia do Porto Francisco Gentil (IPO‑PORTO), 4200‑072 Porto, Portugal
| |
Collapse
|
24
|
Zhou S, Skaar DJ, Jacobson PA, Huang RS. Pharmacogenomics of Medications Commonly Used in the Intensive Care Unit. Front Pharmacol 2018; 9:1436. [PMID: 30564130 PMCID: PMC6289166 DOI: 10.3389/fphar.2018.01436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022] Open
Abstract
In the intensive care unit (ICU) setting, where highly variable and insufficient drug efficacies, as well as frequent and unpredictable adverse drug reactions (ADRs) occur, pharmacogenomics (PGx) offers an opportunity to improve health outcomes. However, PGx has not been fully evaluated in the ICU, partly due to lack of knowledge of how genetic markers may affect drug therapy. To fill in this gap, we conducted a review to summarize the PGx information for the medications commonly encountered in the ICU.
Collapse
Affiliation(s)
- Shuqin Zhou
- Department of Emergency and Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.,Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Debra J Skaar
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Pamala A Jacobson
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - R Stephanie Huang
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
25
|
Awad ME, Padela MT, Sayeed Z, Abaab L, El-Othmani MM, Saleh KJ. Pharmacogenomics Testing for Postoperative Pain Optimization Before Total Knee and Total Hip Arthroplasty. JBJS Rev 2018; 6:e3. [PMID: 30300249 DOI: 10.2106/jbjs.rvw.17.00184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Mohamed E Awad
- Bone and Biomechanics Laboratories, Medical College of Georgia-Augusta University, Augusta, Georgia
| | - Muhammad Talha Padela
- Resident Research Partnership, Detroit, Michigan.,Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois.,Michigan Musculoskeletal Institute, Madison Heights, Michigan
| | - Zain Sayeed
- Resident Research Partnership, Detroit, Michigan.,Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois.,Michigan Musculoskeletal Institute, Madison Heights, Michigan
| | - Leila Abaab
- Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan
| | - Mouhanad M El-Othmani
- Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- Michigan Musculoskeletal Institute, Madison Heights, Michigan
| |
Collapse
|
26
|
Gutteridge T, Kumaran M, Ghosh S, Fainsinger R, Klepstad P, Tarumi Y, Damaraju S, Baracos VE. Single-Nucleotide Polymorphisms in TAOK3 Are Associated With High Opioid Requirement for Pain Management in Patients With Advanced Cancer Admitted to a Tertiary Palliative Care Unit. J Pain Symptom Manage 2018; 56:560-566. [PMID: 30031856 DOI: 10.1016/j.jpainsymman.2018.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Different amounts of opioid are required for the relief of cancer pain in different individuals, raising the possibility that genetic factors play a role. We tested the hypothesis that genetic variations in the TAOK3 (TAO kinase 3, encoding serine/threonine-protein kinase) explain some of the interindividual variations related to the morphine-equivalent daily dose (MEDD) in patients with cancer. EXPERIMENTAL DESIGN We selected two single-nucleotide polymorphisms (SNPs) in the TAOK3, reported earlier to associate with higher MEDD in postoperative pain based on genome-wide association study. We investigated their association with MEDD in Canadian patients with cancer (n = 110) admitted to a tertiary palliative care unit. SNPs analyzed were rs1277441 (C/T, C = minor allele) and rs795484 (A/G, A = minor allele). RESULTS Minor allele frequencies in our population were 0.29 (rs1277441) and 0.28 (rs795484). These SNPs were in perfect linkage disequilibrium (r2 = 0.97). SNPs in TAOK3 showed a significant association with mean MEDD ≥800 mg. For rs795484, MEDD values ≥800 mg occurred in patients who were GG (7%), GA (18%), and AA (57%) (P = 0.004; Fisher's exact test); similar results were obtained for rs1277441. Homozygous variants for either SNP had received higher numbers of different opioids (P = 0.021). CONCLUSION In this cohort of patients with advanced cancer pain, TAOK3 SNPs were associated with opioid doses. This result supports the original findings from a GWAS in postoperative patients. The proportions of variant homozygotes (8.2% of patients) and their requirement for higher doses of opioids would appear potentially clinically important and should be validated in further studies.
Collapse
Affiliation(s)
| | - Mahalakshmi Kumaran
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Robin Fainsinger
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yoko Tarumi
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Sambasivarao Damaraju
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie E Baracos
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
27
|
Yokoshima Y, Sumitani M, Nishizawa D, Nagashima M, Ikeda K, Kato R, Hozumi J, Abe H, Azuma K, Tsuchida R, Yamada Y. Gamma-aminobutyric acid transaminase genetic polymorphism is a candidate locus for responsiveness to opioid analgesics in patients with cancer pain: An exploratory study. Neuropsychopharmacol Rep 2018; 38:175-181. [PMID: 30277654 PMCID: PMC7292329 DOI: 10.1002/npr2.12030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/31/2018] [Accepted: 08/03/2018] [Indexed: 01/03/2023] Open
Abstract
Aim Cancer pain impairs not only physical functions but also social functions and roles. Consequently, the overall health‐related quality of life of patients with cancer pain deteriorates. Opioid analgesics are recommended for treating moderate to strong cancer pain. Advances in human genome research have fueled a growing interest to understand individual differences in responsiveness to opioid analgesics. This study aimed to explore and identify novel loci for genes predisposing an individual to opioid analgesic responsiveness. Methods A total of 71 cancer patients rated their pain on an 11‐point numerical rating scale twice before and after increasing opioid analgesics. A genomewide association study focusing on single nucleotide polymorphisms (SNPs) was conducted to associate pain decrease with increased dosage of opioid analgesics based on weight (ie, responsiveness to opioid analgesics). A genomewide significance (P < 5E‐8) was set for multiplicity of analyses to control for false positives. Results Two SNPs passed the genomewide threshold for significance. One exonic SNP (rs1641025) was located in the ABAT [4‐aminobutyrate aminotransaminase (GABA transaminase)] gene on chromosome 16. The other SNP (rs12494691) was located on chromosome 3, which was not associated with any known genes. These SNPs were not associated with opioid‐related adverse effects. Conclusions Our results preliminarily suggest that both SNPs might be potential candidate loci for responsiveness to opioid analgesics, and GABA transaminase might be a possible target for developing adjuvant pharmacotherapy with opioid analgesics in adjuvant pharmacotherapy. Our results should be validated in a large‐scale study with a larger sample size. A genome‐wide association study revealed two candidate single nucleotide polymorphisms for responsiveness to opioid analgesics in patients with cancer pain, one of which locates on the GABA transaminase gene.
![]()
Collapse
Affiliation(s)
- Yaeko Yokoshima
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Medical Center, Sakura Hospital, Chiba, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ryoji Kato
- Department of Surgery, Toho University Medical Center, Sakura Hospital, Chiba, Japan
| | - Jun Hozumi
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroaki Abe
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Azuma
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Rikuhei Tsuchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | | |
Collapse
|
28
|
Kaye AD, Mahakian T, Kaye AJ, Pham AA, Hart BM, Gennuso S, Cornett EM, Gabriel RA, Urman RD. Pharmacogenomics, precision medicine, and implications for anesthesia care. Best Pract Res Clin Anaesthesiol 2018; 32:61-81. [DOI: 10.1016/j.bpa.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/30/2018] [Indexed: 01/28/2023]
|
29
|
Olesen AE, Grønlund D, Gram M, Skorpen F, Drewes AM, Klepstad P. Prediction of opioid dose in cancer pain patients using genetic profiling: not yet an option with support vector machine learning. BMC Res Notes 2018; 11:78. [PMID: 29374492 PMCID: PMC5787255 DOI: 10.1186/s13104-018-3194-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/19/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Use of opioids for pain management has increased over the past decade; however, inadequate analgesic response is common. Genetic variability may be related to opioid efficacy, but due to the many possible combinations and variables, statistical computations may be difficult. This study investigated whether data processing with support vector machine learning could predict required opioid dose in cancer pain patients, using genetic profiling. Eighteen single nucleotide polymorphisms (SNPs) within the µ and δ opioid receptor genes and the catechol-O-methyltransferase gene were selected for analysis. RESULTS Data from 1237 cancer pain patients were included in the analysis. Support vector machine learning did not find any associations between the assessed SNPs and opioid dose in cancer pain patients, and hence, did not provide additional information regarding prediction of required opioid dose using genetic profiling.
Collapse
Affiliation(s)
- Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Debbie Grønlund
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mikkel Gram
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Frank Skorpen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Pål Klepstad
- Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Anesthesiology and Intensive Care Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| |
Collapse
|
30
|
Nerenz RD, Tsongalis GJ. Pharmacogenetics of Opioid Use and Implications for Pain Management. J Appl Lab Med 2018; 2:622-632. [PMID: 33636885 DOI: 10.1373/jalm.2017.023150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/05/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Opioid analgesics are frequently prescribed to manage acute and chronic pain, but individual differences in opioid response make effective pain control in all patients an elusive goal. Furthermore, the risk of addiction following opioid consumption varies among individual patients. Although many psychosocial factors contribute to an individual's opioid response and risk for addiction, a strong genetic component has also been demonstrated. CONTENT Opioids undergo substantial enzymatic modification that can generate metabolites with either increased or decreased opioid activity relative to the parent compound. To elicit their analgesic effect, parent compounds and active metabolites must be transported into the central nervous system where they bind to opioid receptors and inhibit neurotransmission. Inherited genetic variants that alter the function of proteins involved in these processes have been associated with differences in opioid response and risk for addiction. Detection of these variants can help guide opioid selection, inform dosing decisions, or encourage use of a nonopioid analgesic. SUMMARY Whereas some genetic variants are clearly associated with differences in opioid response and have been included in consensus clinical practice guidelines, the impact of other variants on opioid response remains unclear. Studies performed to date have generated promising results, but inconsistent findings, reimbursement challenges, and the lack of robust decision support tools have hampered widespread adoption of pharmacogenetic testing to guide pain management treatment decisions. Future work involving the simultaneous evaluation of large numbers of variants and demonstration of a clear clinical benefit provided by pharmacogenetic testing will be required to overcome these obstacles.
Collapse
Affiliation(s)
- Robert D Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Gregory J Tsongalis
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| |
Collapse
|
31
|
Hooten WM, Brummett CM, Sullivan MD, Goesling J, Tilburt JC, Merlin JS, St Sauver JL, Wasan AD, Clauw DJ, Warner DO. A Conceptual Framework for Understanding Unintended Prolonged Opioid Use. Mayo Clin Proc 2017; 92:1822-1830. [PMID: 29108841 DOI: 10.1016/j.mayocp.2017.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 12/12/2022]
Abstract
An urgent need exists to better understand the transition from short-term opioid use to unintended prolonged opioid use (UPOU). The purpose of this work is to propose a conceptual framework for understanding UPOU that posits the influence of 3 principal domains that include the characteristics of (1) individual patients, (2) the practice environment, and (3) opioid prescribers. Although no standardized method exists for developing a conceptual framework, the process often involves identifying corroborative evidence, leveraging expert opinion to identify factors for inclusion in the framework, and developing a graphic depiction of the relationships between the various factors and the clinical problem of interest. Key patient characteristics potentially associated with UPOU include (1) medical and mental health conditions; (2) pain etiology; (3) individual affective, behavioral, and neurophysiologic reactions to pain and opioids; and (4) sociodemographic factors. Also, UPOU could be influenced by structural and health care policy factors: (1) the practice environment, including the roles of prescribing clinicians, adoption of relevant practice guidelines, and clinician incentives or disincentives, and (2) the regulatory environment. Finally, characteristics inherent to clinicians that could influence prescribing practices include (1) training in pain management and opioid use; (2) personal attitudes, knowledge, and beliefs regarding the risks and benefits of opioids; and (3) professionalism. As the gatekeeper to opioid access, the behavior of prescribing clinicians directly mediates UPOU, with the 3 domains interacting to determine this behavior. This proposed conceptual framework could guide future research on the topic and allow plausible hypothesis-based interventions to reduce UPOU.
Collapse
Affiliation(s)
- W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN.
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Jenna Goesling
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Jon C Tilburt
- Department of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Jessica S Merlin
- Division of Infectious Diseases, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN
| |
Collapse
|
32
|
Affiliation(s)
- Louise Ladebo
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg & Clinical Institute, Aalborg University, Denmark
| | - Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg & Clinical Institute, Aalborg University, Denmark.,Department of Drug Design & Pharmacology, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
33
|
Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics. Scand J Pain 2017; 17:193-200. [DOI: 10.1016/j.sjpain.2017.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022]
Abstract
Abstract
Background
As pain is often a comorbid condition, many patients use opioid analgesics in combination with several other drugs. This implies a generally increased risk of drug interactions, which along with inherent pharmacogenetic variability and other factors may cause differences in therapeutic response of opioids.
Aim
To provide an overview of interactions and pharmacogenetic variability of relevance for individual differences in effect and tolerability of opioid analgesics, which physicians and other healthcare professionals should be aware of in clinical practice.
Methods
The article was based on unsystematic searches in PubMed to identify literature highlighting the clinical impact of drug interactions and pharmacogenetics as sources of variable response of opioid analgesics.
Results
Cytochrome P450 (CYP)-mediated metabolism is an important process for both clinically relevant interactions and pharmacogenetic variability of several opioids. Concomitant use of CYP inhibitors (e.g. paroxetine, fluoxetine and bupropion) or inducers (e.g. carbamazepine, phenobarbital and phenytoin) could counteract the clinical effect or trigger side effects of analgesics in the same manner as genetically determined differences in CYP2D6-mediated metabolism of many opioids. Moreover, combination treatment with drugs that inhibit or induce P-glycoprotein (ABCB1), a blood-brain barrier efflux transporter, may alter the amount (‘dose’) of opioids distributed to the brain. At the pharmacodynamic level, it is crucial to be aware of the potential risk of interaction causing serotonergic syndrome when combining opioids and serotonergic drugs, in particular antidepressants inhibiting serotonin reuptake (SSRIs and SNRIs). Regarding pharmacogenetics at the receptor level of pain treatment, the knowledge is currently scarce, but an allelic variant of the μ1 opioid receptor (OPRM1) gene has been associated with higher dosage requirement to achieve analgesia.
Conclusions and implications
Drug interactions and pharmacogenetic differences may lead to therapeutic failure or serious side effects of opioid analgesics. Many interactions involve combinations with antidepressants and antiepileptics, which are highly relevant drugs in patients suffering from pain. To prevent unfavourable drug interactions it is important that clinicians pay close attention and use electronic drug interaction checkers when treatments are initiated or discontinued. For the management of issues related to pharmacogenetic differences, blood-based CYP genotyping is available as routine test at many laboratories, and provide a valuable tool for proper choice of drugs and doses for treatment of pain and other diseases.
Collapse
|
34
|
Sekhri NK, Cooney MF. Opioid Metabolism and Pharmacogenetics: Clinical Implications. J Perianesth Nurs 2017; 32:497-505. [PMID: 28938988 DOI: 10.1016/j.jopan.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
|
35
|
Abstract
Osteoarthritis (OA), the most common form of arthritis, causes pain and disability, as well as emotional distress. While total joint replacement is one of the most effective treatments available for improving the quality of life in people with severe OA, it is not suitable for all patients and all joints. Current pharmacological analgesics have limited efficacy, and their use is often restricted by adverse events. Medications that might reduce pain by slowing or preventing structural disease remain elusive. Our increasing understanding of the complex mechanisms that underlie OA pain offers a wide range of potential new treatment targets. New drugs for OA pain might come from repurposing those developed for other conditions, as well as novel compounds targeting pain mechanisms specific to the joint. Here we discuss the mechanisms of OA pain and its therapeutic implications. We explore evolving treatment modalities, including combination treatment. We review recent research and patents pointing to future OA therapies. We discuss the potential for biomarkers to facilitate drug development and targeting.
Collapse
Affiliation(s)
- David A Walsh
- 1 Arthritis Research UK Pain Centre, University of Nottingham, UK.,2 Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK.,3 NIHR Nottingham BRC, UK.,4 Sherwood Forest Hospitals NHS Foundation Trust, UK.,5 Nottingham University Hospitals NHS Trust, UK
| | - Joanne Stocks
- 1 Arthritis Research UK Pain Centre, University of Nottingham, UK.,2 Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK.,3 NIHR Nottingham BRC, UK
| |
Collapse
|
36
|
Abstract
The medical management of pain in chronic pancreatitis continues to pose significant challenges for clinicians caring for these patients. There are increasing data, suggesting that pain in chronic pancreatitis is largely due to peripheral and central sensitization that evolves, over time, as a result of nociceptive afferent associated with chronic inflammation and fibrosis of the pancreas. In many instances, patients rapidly progress to requiring opioid analgesics for the adequate treatment of pain despite the unequivocal risks associated with the long-term use of these drugs. Centrally acting drugs, such as gabapentinoids, appear to be effective means of treating pain due to their inhibition of neurotransmitters involved in central sensitization, but side effects limit their use. The present review explores the evidence for various non-pharmacologic and pharmacologic treatments for pain in chronic pancreatitis.
Collapse
|
37
|
Koolen SL, Van der Rijt CC. Is there a role for pharmacogenetics in the dosing of fentanyl? Pharmacogenomics 2017; 18:417-419. [PMID: 28346084 DOI: 10.2217/pgs-2017-0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Stijn Lw Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Carin Cd Van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Netherlands Comprehensive Cancer Organisation, The Netherlands
| |
Collapse
|
38
|
Nielsen LM, Christrup LL, Sato H, Drewes AM, Olesen AE. Genetic Influences of OPRM1, OPRD1 and COMT on Morphine Analgesia in a Multi-Modal, Multi-Tissue Human Experimental Pain Model. Basic Clin Pharmacol Toxicol 2017; 121:6-12. [PMID: 28084056 DOI: 10.1111/bcpt.12757] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/06/2017] [Indexed: 12/18/2022]
Abstract
Human studies on experimentally induced pain are of value to elucidate the genetic influence on morphine analgesia under controlled conditions. The aim of this study was to investigate whether genetic variants of mu-, kappa- and delta-opioid receptor genes (OPRM1, OPRK1 and OPRD1) and catechol-O-methyltransferase gene (COMT) are associated with the morphine analgesia. The study was a randomized, double-blind, two-way, crossover, single-dose study conducted in 40 healthy participants, where morphine was compared with placebo. Pain was induced by contact heat, muscle pressure, bone pressure, rectal stimulations (mechanical, electrical and thermal) and cold pressor test (immersion of the hand into ice water). Sixteen genetic polymorphisms of four candidate genes were explored. Variability in morphine analgesia to contact heat stimulation was associated with COMT rs4680 (p = 0.04), and rectal thermal stimulation was associated with OPRM1 rs9479757 (p = 0.03). Moreover, in males, variability in morphine analgesia to rectal thermal stimulation was associated with OPRD1 polymorphisms: rs2234918 (p = 0.01) and rs533123 (p = 0.046). The study was explorative and hypothesis-generating due to the relatively small study size. However, results suggest that genetic variants in the COMT and OPRM1 irrespective of gender, and OPRD1 in males may contribute to the variability in morphine analgesia in experimental pain models.
Collapse
Affiliation(s)
- Lecia M Nielsen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lona L Christrup
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hiroe Sato
- Interstitial Lung Disease Unit, Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, UK
| | - Asbjørn M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne E Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
39
|
HRONOVÁ K, POKORNÁ P, POSCH L, SLANAŘ O. Sufentanil and Midazolam Dosing and Pharmacogenetic Factors in Pediatric Analgosedation and Withdrawal Syndrome. Physiol Res 2016; 65:S463-S472. [DOI: 10.33549/physiolres.933519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Our aim was to describe the effect of dosing and genetic factors on sufentanil- and midazolam-induced analgosedation and withdrawal syndrome (WS) in pediatric population. Analgosedation and withdrawal syndrome development were monitored using COMFORT-neo/-B scores and SOS score. Length of therapy, dosing of sufentanil and midazolam were recorded. Genotypes of selected candidate polymorphisms in CYP3A5, COMT, ABCB1, OPRM1 and PXR were analysed. In the group of 30 neonates and 18 children, longer treatment duration with midazolam of 141 h (2 – 625) vs. 88 h (7 – 232) and sufentanil of 326.5 h (136 – 885) vs. 92 h (22 – 211) (median; range) was found in the patients suffering from WS vs. non-WS group, respectively. Median midazolam cumulative doses were in the respective values of 18.22 mg/kg (6.93 – 51.25) vs. 9.94 mg/kg (2.12 – 49.83); P=0.03, and the respective values for sufentanil were 88.60 µg/kg (20.21 – 918.52) vs. 21.71 µg/kg (4.5 – 162.29); P<0.01. Cut off value of 177 hours for sufentanil treatment duration represented predictive factor for WS development with 81 % sensitivity and 94 % specificity. SNPs in the candidate genes COMT, PXR and ABCB1 affected the dosing of analgosedative drugs, but were not associated with depth of analgosedation or WS. Cumulative dose and length of analgosedative therapy with sufentanil significantly increases the risk of WS in critically ill neonates and children.
Collapse
Affiliation(s)
- K. HRONOVÁ
- Institute of Pharmacology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | | |
Collapse
|
40
|
Oosten AW, Matic M, van Schaik RH, Look MP, Jongen JL, Mathijssen RH, van der Rijt CC. Opioid treatment failure in cancer patients: the role of clinical and genetic factors. Pharmacogenomics 2016; 17:1391-403. [PMID: 27472837 DOI: 10.2217/pgs-2016-0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM To identify clinical and genetic factors associated with outcome of opioid treatment. PATIENTS & METHODS We performed an exploratory analysis in a cohort of 353 patients treated with fentanyl, morphine, oxycodone and/or hydromorphone for cancer-related pain, exploring selected clinical and pharmacogenetic factors for a correlation with treatment failure for all and per type of opioid. RESULTS Use of adjuvant pain medication, intensity of pain at rest and age were associated with treatment failure in the various cohorts. Only the genetic variants rs12948783 (RHBDF2) and rs7016778 (OPRK1) correlated statistically significant in univariate, but not in multivariable analysis. CONCLUSION Several clinical and genetic factors were identified that warrant further study to clarify their role and use in opioid treatment.
Collapse
Affiliation(s)
- Astrid W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maja Matic
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands.,Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ron H van Schaik
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
| | - Maxime P Look
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost L Jongen
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Ron H Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Carin C van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| |
Collapse
|
41
|
Abstract
Pain is a common symptom that can be complex to treat. Analgesic medications are the mainstay treatment, but there is wide interindividual variability in analgesic response and adverse effects. Pharmacogenomics is the study of inherited genetic traits that result in these individual responses to drugs. This narrative review will attempt to cover the current understanding of the pharmacogenomics of pain, examining common genes affecting metabolism of analgesic medications, their distribution throughout the body, and end organ effects.
Collapse
Affiliation(s)
- Sonya Ting
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Stephan Schug
- Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia; Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, University of Western Australia Anaesthesiology Unit, Royal Perth Hospital, Perth, WA, Australia
| |
Collapse
|
42
|
Brooks A, Kominek C, Pham TC, Fudin J. Exploring the Use of Chronic Opioid Therapy for Chronic Pain: When, How, and for Whom? Med Clin North Am 2016; 100:81-102. [PMID: 26614721 DOI: 10.1016/j.mcna.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article provides a broad overview regarding intent to initiate and consider ongoing chronic opioid therapy (COT) for treatment of chronic noncancer pain (CNCP). COT should be an individualized decision based on a comprehensive evaluation, assessment, and monitoring. It is imperative that providers discuss various risks and benefits of COT initially and at follow-up visits, and continue appropriate monitoring and follow-up at regular intervals. The decision to initiate or continue opioid therapy is based on clinical judgment; however, it is understood that opioid and other medication therapy represent one piece of the complete treatment plan for patients with CNCP.
Collapse
Affiliation(s)
- Abigail Brooks
- Pain Management, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Courtney Kominek
- Pain Management, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Thien C Pham
- Pain & Palliative Care, Stratton VA Medical Center, Albany, NY, USA
| | - Jeffrey Fudin
- Pain Management, PGY2 Pain & Palliative Care Pharmacy Residency, Stratton VA Medical Center, Albany, NY, USA; Western New England University College of Pharmacy, Springfield, MA, USA; Albany College of Pharmacy & Health Sciences, Albany, NY, USA; University of Connecticut School of Pharmacy, Storrs, CT, USA.
| |
Collapse
|
43
|
|