Kashi Health offers testing for pain management biomarkers to help maximize the effectiveness of analgesic drug use.
Managing chronic pain is a challenge for healthcare providers because of each patient's unique tolerance to pain, and differing reactions to prescribed medications. Unpleasant opioid side effects, such as nausea, vomiting, constipation and sedation, are common with pain management medication. The side effects can lead to work absences, poor work performance, the risk of job loss, and a diminished quality of life. An individual's genetic makeup may predispose them to adverse effects of pain and reduced efficacy of medications. Pharmacogenomics may help connect the dots towards mitigating adverse drug reactions among genetically-vulnerable individuals.
Currently, the labels of more than 100 U.S. Food and Drug Administration-approved medications include information about the effect of genetic variations on drug efficacy. For physicians to make optimal prescribing decisions for these drugs, it is imperative that they have information on each patient's unique genetic background. Importantly, there are several common, well-documented genetic variations that substantially reduce or increase the functionality of enzymes involved in metabolism of frequently prescribed pain management drugs. If a patient harbors one of these mutations it may have a dramatic impact on their ability to metabolize many commonly prescribed analgesics, resulting in reduced efficacy of the medication, or increased risk of adverse drug reactions.
Kashi Health's Pain Management Panel provides physicians with the genetic information they need to make the best possible selection of analgesic drugs and dosing regimens for patients. This intelligent approach to the prescription of pain management medications can drastically improve patient outcomes.
Potential Benefits of Testing with the Pain Management Genetic Panel:
- Decreased adverse drug reactions
- Reduced trial and error period for an effective medication
- Improved dosage recommendations for therapeutic effect
Gene Tests Included in the Pain Management Panel
|GENES TESTS||EFFECT ON PAIN MANAGEMENT|
|CYP2D6||Key role in the metabolism of opioids including: codeine, tramadol, and oxycodone|
|CYP2C19||Impacts dosages requirements for tricyclic antidepressants|
|CYP2C9||Crucial to the breakdown of NSAIDS including: diclofenac, naproxen, and ibuprofen|
|COMT||Effects morphine dosage requirements and perceptions of pain|
Example Table of CYP Metabolizers by Phenotype
Results from Kashi Health's Pain Management Panel classify patients by how effectively they metabolize a medication. This classification is based on how many copies of functional or variant alleles they inherited. In general, the genetic variability of CYP genes can be grouped into four phenotypes: ultra-rapid metabolizers (UM), normal (extensive) metabolizers (EM), intermediate metabolizers (IM) and poor metabolizers (PM).
|TYPE OF METABOLIZER||GENETIC VARIABILITY EFFECTS|
|Ultra-rapid metabolizer (UM)||Increased enzymatic activity due to duplications or multiplications of the functional allele|
|Extensive metabolizer (EM)||Normal enzymatic activity due to the presence of at least one functional allele|
|Intermediate metabolizer (IM)||Moderately-decreased enzymatic activity with either two decreased activity alleles or one decreased activity allele and one null allele|
|Poor metabolizer (PM)||Lack of enzyme activity as a result of two null (non-functional) alleles|
The Clinical Utility of Pharmacogenomics Testing: the CYP2D6 and Codeine Story
Codeine is a pro-drug that only creates an analgesic effect once it has been converted into morphine by the CYP2D6 enzyme. If a patient has the genetic mutations that classify them as a poor metabolizer, codeine likely will be ineffective at reducing their pain. In contrast, up to two percent of the population carries genetic mutations that make them ultra-rapid metabolizers of codeine, putting them at risk for toxicity if prescribed this medication. Pharmacogenomics allows clinicians to identify patients who are at risk for this type of ineffective drug response, or adverse reaction, and enables the selection of more appropriate medications.
How Common are Variant Alleles in CYP genes?
Variant alleles for genes in the CYP pathway are common. However, prevalence differs among ethnic populations. For example, when considering CYP2D6, up to 20 percent of African Americans, and 10 percent of Caucasians have the poor metabolizer phenotype, whereas this phenotype is rarely observed in Asians. Because of this large variation in patient phenotypes it is important to determine each individual's unique genetic background in order to help predict their response to pain medications.
For more information about the clinical implications of pharmacogenomics please visit: www.pharmgkb.org.
Limitations of Pharmacogenomics
Interactions with environmental elements and other medications need to be taken into consideration with the genetic makeup of the patient when determining efficacy of a drug. Rare genetic differences may not be detected because the panel screens for the most common and well documented gene variants.
Get Started Today
Make Kashi Health's Genetic Testing part of your patient's treatment plan today.
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