Pharmacogenomics for Personalized Pain Medicine
Recorded: Tuesday, November 10, 2020
Pharmacogenomic (PGx) testing has the potential to accelerate pharmacological response and improve outcomes for patients with pain. PGx is the study of the role of the genome in drug response, with a focus on genetic variants that affect pharmacokinetics (e.g. absorption, distribution, metabolism, elimination) and pharmacodynamics (e.g. receptor binding and chemical interactions). Approximately 60% of variation in individual responses to pain medications relate to genetic polymorphisms. Genes encode receptors on which drugs act, for example, the three classic opioid receptors (mu, kappa and delta). Many promising gene tests may have future clinical application. The Clinical Pharmacogenomics Implementation Consortium (CPIC) has created peer reviewed, evidence-based, updatable, and detailed gene/drug clinical practice guidelines with recommendations for prescribing actions if there are sufficient evidence. Medications used for chronic pain with existing CPIC prescribing actions assigned include amitriptyline, nortriptyline, carbamazepine, oxcarbazepine, tramadol, oxycodone, codeine and venlafaxine. With many available tests commercially available to patients, PGx is emerging as another tool for patients with chronic pain and their prescribers for shared decision-making, predicting response to drugs in situations where poor outcomes have occurred previously, and guiding dose titration. Despite the vast potential for pharmacogenomics to tailor the management of pain and improve patient outcomes, many barriers to its implementation exist, including the limited strength of available evidence, cost, turnaround time, and prescribers’ lack of familiarity with interpretation of test results.
All speakers consented to session being recorded in our planning meeting.
Katherine Siminovitch, M.D., FRCP(C)
Katherine Siminovitch is the Director of the Lunenfeld’s Genomic Medicine Program and the Clinical Genomics Centre and the Fred A. Litwin Family Centre of Genetic Medicine at Mount Sinai Hospital and University Health Network. She is the Chief Science Advisor at InageneTM. She will outline the basics of the science of pharmacogenomics (PGx) and explore current testing available for patients with pain. Dr. Siminovitch will also provide insight into the future promise of PGx for pain medicine with the array of genes that may hold answers to clinical questions. Read more
Laura Murphy, BScPhm, PharmD, MSc, RPh
Laura Murphy is a Pharmacist in the Comprehensive Integrated Pain Program, working with patients with chronic pain and complex medication issues, and a Pharmacy Clinical Leader at University Health Network (UHN). She is a member of the Project ECHO Ontario Chronic Pain and Opioid Stewardship team, the Expert Advisory Panel of the Canadian Pain Task Force, and co-chair of the University of Toronto Centre for the Study of Pain’s Interfaculty Pain Curriculum. Her research is focused on pharmacy practice and opioids and cannabis for chronic pain. Read more
Andrea Furlan, MD, PhD
Andrea Furlan is a Physiatrist and senior scientist at Toronto Rehab UHN, and Associate Professor of Medicine at the University of Toronto.
Dr. Furlan is an early adopter of pharmacogenomics (PGx), recommending testing to patients with chronic pain in her clinic to support medication management. Thus far, many patients have been very interested in PGx testing, sometimes seeking it out on their own and often paying out of pocket. Despite this perceived interest from patients, we have identified many barriers to implementation in our clinic and for pain medicine on a broader level. Among other challenges, there is a strong need for education for physicians and other healthcare providers. Read more
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