Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


What is the answer for pain?


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.


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:

More articles from Studies and Analyses:

nachricht Diagnoses: When Are Several Opinions Better Than One?
19.07.2016 | Max-Planck-Institut für Bildungsforschung

nachricht High in calories and low in nutrients when adolescents share pictures of food online
07.04.2016 | University of Gothenburg

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: Etching Microstructures with Lasers

Ultrafast lasers have introduced new possibilities in engraving ultrafine structures, and scientists are now also investigating how to use them to etch microstructures into thin glass. There are possible applications in analytics (lab on a chip) and especially in electronics and the consumer sector, where great interest has been shown.

This new method was born of a surprising phenomenon: irradiating glass in a particular way with an ultrafast laser has the effect of making the glass up to a...

Im Focus: Light-driven atomic rotations excite magnetic waves

Terahertz excitation of selected crystal vibrations leads to an effective magnetic field that drives coherent spin motion

Controlling functional properties by light is one of the grand goals in modern condensed matter physics and materials science. A new study now demonstrates how...

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Ice shelf vibrations cause unusual waves in Antarctic atmosphere

25.10.2016 | Earth Sciences

Fluorescent holography: Upending the world of biological imaging

25.10.2016 | Power and Electrical Engineering

Etching Microstructures with Lasers

25.10.2016 | Process Engineering

More VideoLinks >>>