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Genetic differences may reduce pain relieving effects of opioids

A comprehensive review of the scientific literature on opioid pain management found that people with a certain gene mutation do not respond as well to opioid pain medications and may need to be managed differently to get relief.

The review was presented at Touro College Research Day at the Touro College of Osteopathic Medicine and the Touro College of Pharmacy campus at 230 West 125th Street in Harlem. The program is organized by the Touro Research Collaborative.

Though there are standard dosages for opioids, studies have shown that patients react differently to them. “Some people don’t seem to respond as well, and doses need to be raised in order to have adequate pain control, but that increases the risks of side effects, including addition,” says Priyank Kumar, PhD, Assistant Professor and Head of Laboratory Research at the Touro College of Pharmacy, who conducted this research with Drs. Zvi Loewy and Maureen Sullivan.

The researchers looked at about 60 studies over a ten-year period to examine a known gene variation, called a single nucleotide polymorphism or SNP, found on an opioid receptor.

The studies showed that people with a difference of one neucleotide – they had an A118G, rather than the standard A118A – had a decreased sensitivity to opioids. The studies showed that people with this polymorphism were also more susceptible to side effects including addiction.

Dr. Kumar and his team are advocating for genetic testing for this polymorphism in patients before patients with chronic or serious pain are prescribed opioids. “Genetic testing is done routinely when treating illnesses like cancer, and many medications are designed based on this information,” says Dr. Kumar. “But for pain medications, such genetic testing is not popular.”

Someone with this polymorphism could be put on a different opioid other than morphine, such as fentanyl. “It will help us in designing a better pain management regime for the patients with A118G polymorphism,” says Dr. Kumar. “Genetic testing may explain and predict many of the clinical responses seen with opioids medications, and may help the clinician identify those patients at genetic risk of opioid misuse and addiction”‘ says Dr. Kumar.