Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

What is the answer for pain?

21.07.2003


Individual genetic differences in drug metabolism in pain medication can lead to severe toxicity or therapeutic failure.



The International Association for the Study of Pain (IASP) defines pain as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." The current analgesic strategies for treating chronic pain and cancer pain are based on the World Health Organization’s (WHO) 1990 analgesic ladder, in which nonsteroidal anti-inflammatory drugs (NSAIDs) or other nonopioid (non-synthetic) analgesics are used first, then followed by a stepwise progression to centrally acting analgesics. But is this general approach to care the best approach? The answer may be as individual as one’s genetics and metabolism.
A New Study Underway

A new study is now underway that explores the relationship between pain and selected medications. It is entitled, "Is Pharmacogenetics the Answer for Pain Management?; Evaluation of the Clinical Efficacy of Genotyping CYP2D6 Variant Alleles for Chronic Pain Patients on Analgesic Therapy, and Monitoring of Plasma Drug Concentrations." The status of the research will be presented by the primary investigator, Paul Jannetto, Ph.D., Medical College of Wisconsin, Milwaukee, WI. Dr. Jannetto will make his remarks during the 55th Annual Meeting of the American Association for Clinical Chemistry (AACC) in Philadelphia, PA July 20-24, 2003. More than 16,000 are expected to attend.



Background

Pain is clinically divided into various types: nociceptive, involving tissue injury as with osteoarthritis; neuropathic or nerve injury, such as diabetic neuropathy; and combination pain, such as cancer or chronic lower back pain. There are also several approaches to treating pain: pharmacotherapy, which uses drugs either alone or in combination; invasive procedures, such as nerve blocks and steroid injections; and adjunct therapies, such as acupuncture, physical therapy and psychotherapy.

Pharmacogenetics is the study of the linkage between an individual’s genetic make-up and that individual’s ability to metabolize a foreign compound. Most therapeutic drugs are metabolized to some extent and the metabolism of these drugs results in either the detoxification and elimination of the drug or the activation of the prodrug to its biologically active form.

Cytochrome P450 enzymes are an important superfamily of proteins that are involved in phase I drug metabolism. Consequently, mutations in cytochrome P450 (CYP) genes, such as CYP2D6, can cause alterations in the way a drug is metabolized. In humans, CYP2D6 affects the metabolism of several clinically important drugs, such as oxycodone, amitriptyline and tramadol, all essential for pain management therapy.

The genetic differences in drug metabolism can therefore lead to severe toxicity or therapeutic failure by altering the relation between the dose and blood concentration of the pharmacologically active drug. Since up to ten percent of Caucasians and up to four percent of most other ethnic groups have decreased CYP2D6 activities (poor metabolizers), they may risk toxic effects if they receive the routine clinical dose of a drug inactivated by CYP2D6.

Objective and Methodology

Accordingly, the study now underway examines the clinical efficacy of genotyping chronic pain patients on analgesic therapy. They have begun by genotyping new and existing patients at the Pain Management Clinic at the Zablocki VA Medical Center and the Froedtert Hospital, both in Milwaukee, WI.

Dr. Jannetto and his colleagues hypothesize that poor drug metabolizers taking analgesics metabolized by CYP2D6 will have higher plasma concentrations and therefore be more likely to experience adverse effects. To test the hypothesis, they will determine the genotype of chronic pain patients being treated with medications metabolized by CYP2D6. The genotype will then be correlated with the plasma concentrations of the various analgesics after steady state levels have been reached. They will also clinically evaluate the patients for adverse reactions as well as the efficacy of the pain management therapy, using verbal and/or visual analogue scales, clinical indices relevant to function and assessments of the use of breakthrough medication.

Significance of This Research

Overall, the results from this study can be used to predict the clinical usefulness of genotyping patients in an attempt to determine the appropriate drug therapy. This is important since prior knowledge of the genotype and drug metabolism could potentially predict the outcome and allow for appropriate adjustment of the dose to prevent adverse reactions from occurring.

Donna Krupa | EurekAlert!
Further information:
http://www.aacc.org

More articles from Studies and Analyses:

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Ocean atmosphere rife with microbes

17.10.2017 | Life Sciences

Neutrons observe vitamin B6-dependent enzyme activity useful for drug development

17.10.2017 | Life Sciences

NASA finds newly formed tropical storm lan over open waters

17.10.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>