Agarwal Deepti, Udoji Mercy A, Trescot Andrea
Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
Atlanta VA Medical Center, Decatur, GA, USA.
Pain Ther. 2017 Jun;6(1):93-105. doi: 10.1007/s40122-017-0069-2. Epub 2017 Apr 13.
Patients see their primary care physicians (PCPs) for a variety of medical conditions, chronic pain being one of the most common. An increased use of prescription medications (especially opioids) has led to an increase in adverse drug reactions and has heightened our awareness of the variability in response to medications. Opioids and other pain adjuvants are widely used, and drug-drug interactions involving these analgesics can be problematic and potentially lethal. Pharmacogenetics has improved our understanding of drug efficacy and response, opened doors to individual tailoring of medical management, and created a series of ethical and economic considerations. Since it is a relatively new field, genetic testing has not been fully integrated into the primary care setting. The purpose of this paper is to review the metabolism of commonly prescribed opioids, discuss the economic and ethical issues, and provide PCPs with an understanding of how to incorporate genetic testing into routine use to improve clinical practice and patient management.
患者因各种医疗状况就诊于他们的初级保健医生（PCP），慢性疼痛是最常见的状况之一。处方药物（尤其是阿片类药物）使用的增加导致药物不良反应增多，并提高了我们对药物反应变异性的认识。阿片类药物和其他疼痛辅助药物被广泛使用，涉及这些镇痛药的药物相互作用可能会产生问题并具有潜在致命性。药物遗传学增进了我们对药物疗效和反应的理解，为个性化医疗管理打开了大门，并引发了一系列伦理和经济方面的考量。由于这是一个相对较新的领域，基因检测尚未完全融入初级保健环境。本文的目的是回顾常用处方阿片类药物的代谢，讨论经济和伦理问题，并让初级保健医生了解如何将基因检测纳入常规使用以改善临床实践和患者管理。
