2013
DOI: 10.1016/j.jpain.2012.10.016
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Personalized Medicine and Opioid Analgesic Prescribing for Chronic Pain: Opportunities and Challenges

Abstract: Use of opioid analgesics for pain management has increased dramatically over the past decade, with corresponding increases in negative sequelae including overdose and death. There is currently no well-validated objective means of accurately identifying patients likely to experience good analgesia with low side effects and abuse risk prior to initiating opioid therapy. This paper discusses the concept of data-based personalized prescribing of opioid analgesics as a means to achieve this goal. Strengths, weaknes… Show more

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Cited by 95 publications
(68 citation statements)
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“…It seems unlikely that this moderate level of prediction using the HOME, by itself, would be sufficient to accurately guide opioid therapy in clinical settings. It is more likely that a predictive algorithm incorporating multiple measures predictive of opioid responses (eg, the HOME, negative affect measures, evoked pain responsiveness, genetic markers) may be necessary to predict opioid responses to a more clinically meaningful extent 4. This predictive approach using a phenotypic/genotypic algorithm avoids the undesirable alternative of directly evaluating analgesic and subjective responsiveness to a test dose of opioids in clinical settings that might otherwise be required to guide treatment decisions.…”
Section: Discussionmentioning
confidence: 99%
“…It seems unlikely that this moderate level of prediction using the HOME, by itself, would be sufficient to accurately guide opioid therapy in clinical settings. It is more likely that a predictive algorithm incorporating multiple measures predictive of opioid responses (eg, the HOME, negative affect measures, evoked pain responsiveness, genetic markers) may be necessary to predict opioid responses to a more clinically meaningful extent 4. This predictive approach using a phenotypic/genotypic algorithm avoids the undesirable alternative of directly evaluating analgesic and subjective responsiveness to a test dose of opioids in clinical settings that might otherwise be required to guide treatment decisions.…”
Section: Discussionmentioning
confidence: 99%
“…Data-based personalized prescribing of opioids for optimization of analgesic effectiveness and mitigate risks of opioid-related mortality and abuse is highly desirable with the potential to benefit patients by raising world clinical care and optimizing cost effectiveness of opioid analgesic therapy [90].…”
Section: Population Analgesic Drug Dosing Adverse Effectsmentioning
confidence: 99%
“…As has been observed, there are not well-validated algorithms for identifying individuals who are the best candidates for opioid therapy [36]. The same can be said for identifying the patients who are most likely to benefit from complementary and nontraditional pain interventions.…”
Section: Future Perspectivementioning
confidence: 99%
“…The same can be said for identifying the patients who are most likely to benefit from complementary and nontraditional pain interventions. A potential approach is the application of 'personalized medicine', defined as "optimizing medication types and dosages for individual patients based upon genetic, biomarker, and other patient-related factors" [36]. PROs may be among the predictors that could help identify the treatments that are best suited for individualized patient care.…”
Section: Future Perspectivementioning
confidence: 99%