Genetic testing is a new area of pain management in which enzymes are studied to help better define what medications may be helpful in treatment. Many physicians assume that if a drug is not working, the patient is probably not taking the medication correctly, or somehow is abusing the drug.
As technology and science has improved, so has our understanding of how various drugs are processed in the body, including many drugs used for pain. We now know what enzymes control the metabolization of drugs into a person’s system, and not all people have the same enzymes in their bodies.
A case in point is my own family. I likely have a missing CYP2D6 enzyme and have passed it on to at least two of my children. Several years ago, one of my sons had knee surgery for a torn muscle. Post-operatively he was given Vicodin. After the surgical anesthesia wore off, in the middle of the night, he was screaming in pain despite taking his medication. We ended up in the ER and changed his medication to Oxycodone. This resolved the problem and he was off the medication within several days. My daughter had a similar issue after surgery, and we again found that Oxycodone worked best to help control the pain. In the past, after surgery, I’ve noticed that Vicodin has done virtually nothing for me, but I just dealt with it. In retrospect, this is not a coincidence, but a genetic variation that now can be tested.
Enzyme Trials
Today, most medication is prescribed on a trial basis and we just see if it works. If it does not, we just look for another treatment. In cancer treatment, genetic testing has become essential; We are learning that medication effectiveness for various tumors can be determined at least partly by various genetic markers. The lessons that we are learning from cancer are now being applied to other areas of medicine. The enzymes responsible for the metabolization and processing of various drugs is starting to be understood. The interactions of various drugs with each other are also being better understood as this chemistry is being determined.
Genetic testing is done for several reasons. There are many drugs that interact; If you are on multiple medications for any number of reasons, testing may help clarify possible interactions and allow for more informed decisions to be made if medications need to be adjusted. The most important reason may be if a person is having trouble with medication effectiveness of treatment. Genetic testing may reveal interactions or enzymes that prevent a medication working properly. If the treatment you are receiving is working, there probably is no reason to undergo genetic testing.
Science and technology are moving forward quickly. The changes in the future may guide us to better tailored treatments for the individual. At this time we are just scratching the surface of understanding these higher levels of information. The future appears bright, but patience is necessary since new treatments take time to safely make it to the market.