Adding Genetic Testing to Evidence-Based Guidelines to Determine the Safest and Most Effective Chronic Pain Treatment for Injured Workers.

Published guidelines for treating injured workers include the need for personalized treatment to manage chronic pain symptoms and increase functional status. However, they often fail to clarify how to objectively personalize these treatments. Further, certain patients need analgesic relief beyond the short term. In these cases, it is not sufficient or reasonable to utilize the typical broad protocol-based justifications for reduction of opioids and other medications in a haphazard manner based purely on poor response, without attempting to elucidate possible pharmacogenetic reasons for this. These guidelines acknowledge the problem of substance abuse and set forth methods for treatment and prevention. Although it has been established in the scientific community that an individual's experience of pain and likelihood for addiction both have genetic components, genetic testing is not routinely included as part of the overall treatment plan for injured workers with chronic pain. Because decisions in cases of workplace injury should be based on scientific evidence, genetic testing results can add some objective information to the existing subjective and objective clinical data; help ascertain the efficacy and potential for toxicity of treatment; and therefore provide more information for accurate clinical decisions. We propose the addition of genetic testing to consensus guidelines for treating injured workers in order to improve patients' functional status, increase productivity, improve safety of prescribing, decrease the likelihood of substance abuse, and save on overall healthcare costs.