How does pharmacogenetic testing alter the treatment course and patient response for chronic-pain patients in comparison with the current “trial-and-error” standard of care?

1. Kelly DeFeo PhD, CRNA, FNP-BC (Nurse Practitioner)^*, 
2. Kristen Sykora MSN, FNP-BC (Nurse Practitioner), 
3. Susan Eley PhD, FNP-BC (Associate Professor and Chair) and
4. Debra Vincent PhD, FNP-BC (Associate Professor and Director)

Article first published online: 7 AUG 2014

DOI: 10.1002/2327-6924.12154

©2014 American Association of Nurse Practitioners

Issue 

Journal of the American Association of Nurse Practitioners

Volume 26,  Issue 10, pages 530–536, October 2014

Abstract

Purpose

To evaluate if pharmacogenetic testing (PT) holds value for pain-management practitioners by identifying the potential applications of pharmacogenetic research as well as applications in practice.

Data sources

A review of the literature was conducted utilizing the databases EBSCOhost, Biomedical Reference Collection, CINAHL, Health Business: Full Text, Health Source: Nursing/Academic Edition, and MEDLINE with the keywords, personalized medicine, cytochrome P450, and phamacogenetics.

Conclusions

Chronic-pain patients present some of the most challenging patients to manage medically. Often paired with persistent, life-altering pain, they might also have oncologic and psychological comorbidities that can further complicate their management. One-step in-office PT is now widely available to optimize management of complicated patients and affectively remove the “trial-and-error” process of medication therapy.

Implications for practice

Practitioners must be familiar with the genetic determinants that affect a patient's response to medications in order to decrease preventable morbidity and mortality associated with drug–drug and patient–drug interactions, and to provide cost-effective care through avoidance of inappropriate medications. Improved pain managements will impove patient outcomes and satisfaction.

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