Commentary — September 2016
Tex Med. 2016;112(9):15-16.
By Kevin Pauza, MD
Chronic pain is a significant problem in the United States as more than 100 million Americans suffer from chronic pain, according to the book Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Opioid medications have been used to help those who suffer. Use of these medications has come under scrutiny. Although these medications can give patients pain relief, increase their function, and improve their quality of life, their use can be risky and life-threatening. Opioid use has led to epidemic levels of unintentional overdoses in the United States.
The U.S. Food and Drug Administration, aware of the situation, acted by adding new warnings on overdose and death with the use of prescription, short-acting opioids. I applaud their efforts.
I wonder if we can do more and take another approach to helping these patients while battling the opioid epidemic.
I believe the use of pharmacogenetics in pain treatment practices could help physicians identify which opioids and dosages would be safer for the patients we treat. Pharmacogenetics is the study of inherited genetic differences in drug metabolic pathways that can affect individual responses to drugs, in terms of therapeutic effects and adverse effects.
Armed with the information we gain from each individual patient's pharmacogenetic profile, we can minimize side effects and eliminate adverse events. I think this approach could help significantly reduce the opioid epidemic caused by the legitimate prescription of opioids.
Within the scope of my practice, I prescribe medications that far too often have puzzling effects on my patients. I frequently have patients present with the same health condition who respond differently to an identical dosage of an identical medication. One patient may experience tremendous benefit while another experiences none. Worse, that second patient will experience adverse reactions to the medication, causing harm and making that patient's situation dangerous and even life-threatening.
During medical school, residency, and my pain management fellowship, I never received pharmacogenetic training. Partnering with a local pharmacist trained in pharmacogenetics is an important component to successfully integrating pharmacogenetics into a prescribing regimen.
The integration of a licensed pharmacist into pharmacogenetics adds expert support for physicians who have neither the time nor expertise to fully implement this new practice. Using a pharmacist as a counselor and interpreter of pharmacogenetic data provides physicians with professional medication guidance and customized patient medication preferences.
All schools of pharmacy have incorporated pharmacogenetics into their core curriculum. Recent PharmD graduates possess a strong knowledge base. Physicians can consult with the progressive pharmacists in their communities who are experts in pharmacodynamics (the study of what a drug does to the body) and pharmacokinetics (the study of the time course of drug absorption, distribution, metabolism, and excretion). There is a strong chance they have received continuing education in pharmacogenetics and can be an expert resource for a physician practice.
Knowing a patient's pharmacogenetic implications before prescribing a new medication will help all of us make better informed prescribing decisions. This genetic guidance is not the ultimate determinant of what medications we prescribe, but in certain patients it could be a critical factor in the prescribing decisionmaking process.
I support broad-based pharmacogenetic testing with pharmacist consultation as applied toward medication therapy management.
Kevin Pauza, MD, is a Tyler pain medicine physician who developed a spine procedure known as Pauza Discseel.
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