Gazzaniga David, Brenton Ashley, Meshkin Brian
Newport Orthopedic Institute, Newport Beach, CA, USA.
Proove Biosciences, 15326 Alton Pkwy, Irvine, CA, 92618, USA.
J Med Case Rep. 2017 Feb 24;11(1):50. doi: 10.1186/s13256-017-1207-5.
Precision medicine is a promising technology in patient care that combines genetic analysis with clinical data, such as health, behavioral, functional, environment, and lifestyle information. Here we present the case of a 54-year old woman who, following an accident, had uncontrolled chronic pain and was subsequently labeled a drug seeker.
A 54-year-old white woman who was experiencing severe calf pain was referred for treatment. Her pain was insufficiently controlled immediately following knee arthroplasty with multiple opioid medications, as well as non-opioids. Precision medicine testing was ordered for her so that we could assess her pain sensitivity objectively to determine if the pill seeker designation was correct and to determine the best medications for her. Based on the Proove profiles, we determined that she had moderately low pain sensitivity, which means that clinically she may underreport pain and may have decreased medication needs. This result suggested that her continued reporting of unresolved pain was probably due to a condition unresolved by her right knee arthroplasty. In addition, she was found to be at low risk of opioid addiction, based on the Proove Opioid Risk Profile. Taken together, along with the high levels of pain she described, we determined that her pain was not properly controlled and that the designation of pill seeker was incorrect. The next step was to determine which medications and which doses would result in the most favorable outcomes for our patient. To determine this, we used the results of the Proove Opioid Response, Proove Drug Metabolism, and Proove Non-Opioid Profiles to guide her treatment. We reduced her pain medications to a single opioid, Vicodin (acetaminophen and hydrocodone), which also eliminated the adverse side effects she experienced.
Precision medicine offers an important health care decision tool which can reduce emotional and physical costs to patients and may reduce the economic health care burden of unnecessary surgeries and ineffective medication. The information provided by these profiles can be used clinically to guide treatment decisions and evaluate patient pain.
精准医学是患者护理中一项很有前景的技术，它将基因分析与临床数据相结合，如健康、行为、功能、环境和生活方式信息。在此，我们介绍一位54岁女性的病例，该女性在一次事故后患有无法控制的慢性疼痛，随后被贴上了药物成瘾者的标签。
一名54岁的白人女性因严重的小腿疼痛前来接受治疗。在膝关节置换术后，使用多种阿片类药物以及非阿片类药物均未能充分控制她的疼痛。为她安排了精准医学检测，以便我们能够客观评估她的疼痛敏感性，确定她是否真的是药物成瘾者，并为她确定最佳药物。根据Proove检测结果，我们确定她的疼痛敏感性为中度偏低，这意味着在临床上她可能对疼痛报告不足，且可能对药物的需求减少。这一结果表明，她持续报告未缓解的疼痛可能是由于右膝关节置换术未能解决的某种状况。此外，根据Proove阿片类药物风险评估，发现她阿片类药物成瘾风险较低。综合考虑她描述的高水平疼痛，我们确定她的疼痛没有得到妥善控制，将她认定为药物成瘾者是不正确的。下一步是确定哪种药物和剂量能为我们的患者带来最有利的结果。为了确定这一点，我们利用Proove阿片类药物反应、Proove药物代谢和Proove非阿片类药物检测结果来指导她的治疗。我们将她的止痛药减至单一阿片类药物维柯丁（对乙酰氨基酚和氢可酮），这也消除了她所经历的不良副作用。
精准医学提供了一个重要的医疗保健决策工具，它可以降低患者的情感和身体成本，并可能减轻不必要手术和无效药物带来的经济医疗负担。这些检测结果所提供的信息可在临床上用于指导治疗决策和评估患者疼痛。
