OPRM1 c.118A>G Polymorphism and Duration of Morphine Treatment Associated with Morphine Doses and Quality-of-Life in Palliative Cancer Pain Settings

Abstract

Despite increased attention on assessment and management, pain remains the most persistent symptom in patients with cancer, in particular in end-of-life settings, with detrimental impact on their quality-of-life (QOL). We conducted this study to evaluate the added value of determining some genetic and non-genetic factors to optimize cancer pain treatment. Eighty-nine patients were included in the study for the evaluation of palliative cancer pain management. The regression analysis showed that age, OPRM1 single nucleotide polymorphism (SNP), as well as the duration of morphine treatment were significantly associated with morphine doses at 24 h (given by infusion pump; p = 0.043, 0.029, and <0.001, respectively). The mean doses of morphine decreased with age but increased with the duration of morphine treatment. In addition, patients with AG genotype c.118A>G OPRM1 needed a higher dose of morphine than AA patients. Moreover, metastases, OPRM1 SNP, age, and gender were significantly associated with the QOL in our population. In particular, AA patients for OPRM1 SNP had significantly lower cognitive function than AG patients, a result not previously reported in the literature. These findings could help increase the effectiveness of morphine treatment and enhance the QOL of patients in regards to personalized medicine.

Genetic Variants Associated with Cancer Pain and Response to Opioid Analgesics: Implications for Precision Pain Management

“…56 In another study by Cajanus et al, 57 women with the GG genotype consumed the highest amount of oxycodone (0.16 mg/kg); however, women with the AA genotype needed the lowest amount of oxycodone (0.12 mg/kg) after breast cancer surgery (P = .003). Similarly, in the study of Hajj et al, 58 the AG genotype of OPRM1 rs1799971 required a higher dose of morphine at 24 hours to achieve adequate analgesic efficacy compared with the AA genotype (AG genotype = 51.37 ± 46.35 mg, AA genotype = 29.97 ± 26.96 mg; P = .01) in 89 patients with multiple types of cancer (eg, breast, gastrointestinal tract, lung, hematology, gynecology, and others).…”

Molecular Genetics and New Medication Strategies for Opioid Addiction

“…Nevertheless, the findings are a critical step forward suggesting that OPRM1 genetics could be potentially useful clinically in determining appropriate opioid medication dose. Recent meta-analysis (37) and other studies (38, 39) also suggest that the A118G rs1799971 allele variant can influence opioid pain management with individuals carrying the A118G rs1799971 allele requiring higher opioid doses than A118A subjects. The fact that the OPRM1 might hold promise as a genetic predictor of opioid medication dose in the setting of addiction treatment and in analgesia could be potentially helpful in identifying non-dependent individuals who might be at potential addiction risk when being treated with opioid prescription medications.…”

Pharmacy education, workforce, practice, and sciences in Lebanon: Benchmarking with the FIP Development Goals

“…-Pharmacogenetic studies have addressed innovative personalised approaches to improve people-centred care in oncology, pain management, and psychiatry (Hajj, 2018;Hajj et al, 2017;Hajj, Khabbaz, Laplanche, & Peoc'h, 2013;Hajj, Obeid, et al, 2019;Hajj et al, 2015); local guidelines were also issued regarding several infectious and chronic disease management (Doocy et al, 2017;Husni et al, 2017;Moghnieh et al, 2020). The extent to which the research results and guidelines are being applied in real life remains to be assessed (Kabbara, Meski, Ramadan, Maaliki, & Salameh, 2018;Noubani, Nasreddine, Sibai, Tamim, & Isma'eel, 2018;Haydar et al, 2019).…”