Faculty Perspectives in Chronic Pain, Part 5 A of 5
The Potential for Improved Prescribing: A Payer PerspectivePayer Perspective
As I have discussed in previous perspectives, the human and economic toll of opioid abuse and misuse is unacceptably high. A multifaceted approach to this serious public health problem is essential and should involve all stakeholders. One emerging area of focus for the effective management of chronic pain is the role of pharmacogenomics and genetic profiling in patient selection and prescribing. According to the National Library of Medicine, personalized medicine is defined as “an emerging practice of medicine that uses an individual’s genetic profile to guide decisions made in regard to the prevention, diagnosis, and treatment of disease. Knowledge of a patient’s genetic profile can help physicians select the proper medication or therapy and administer it using the proper dose or regimen.”1 Based on the explosion of genetic information that has followed the sequencing of the human genome, a growing contingent of researchers, healthcare clinicians, and an increasing number of patients, are calling for a more personalized approach to medical care, aimed at tailoring treatments based on an individual’s genetic information.
In the main article in this publication, the author reviews current evidence supporting the use of a personalized medicine approach for the selection and use of medications in the treatment of chronic pain. This is an area that is certainly open to additional exploration by the medical community. As was noted in a 2013 article by Bruehl and colleagues, “There is currently no well-validated objective means of accurately identifying patients likely to experience good analgesia with low side effects and abuse risk prior to initiating opioid therapy.”2 In that article, the authors conclude that further investigation is warranted in this area and that clinical trials using pharmacogenomics information will need to be initiated. Similarly, in the current article, the author concludes, “A pharmacogenomics-based approach to pain management may allow rational drug selection, resulting in improved treatment efficacy and toxicity profiles. However, in reality, available data supporting the use of identified genetic biomarkers in routine clinical practice to predict an individual’s response to pain medication is unconvincing.” At this point, it is evident that using genetic markers to guide opioid prescribing is an area ripe for further exploration.
As we continue to balance the need to appropriately treat those with chronic pain with an awareness of the potential risks for opioid misuse, a personalized medicine approach will become increasingly more important for assisting clinicians with prescribing the most effective and safest treatment options. However, much more data are needed before this approach will become mainstream.
- National Library of Medicine. Genetics Home Reference. http://ghr.nlm.nih.gov/glossary=personalizedmedicine. Accessed June 11, 2015.
- Bruehl S, Apkarian AV, Ballantyne JC, et al. Personalized medicine and opioid analgesic prescribing for chronic pain: opportunities and challenges. J Pain. 2013;14:103-113.
Pharmacotherapy, which remains the cornerstone of chronic pain management, includes analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs), the more potent opioids, and adjunct therapies such as antidepressants and anticonvulsants.1 It is well-recognized that interindividual differences exist in the general population in terms of pain perception, response to analgesic treatment, and [ Read More ]
As pharmacists and caregivers, we have all experienced situations in which patients and loved ones continue to experience pain after being treated with proven, advanced analgesics. It leads us to question whether the correct dose was administered, whether the appropriate diagnosis was made, and even whether some other physiologic or [ Read More ]