Personalized medicine and opioid analgesic prescribing for chronic pain: Opportunities and challenges

Stephen Bruehl, A. Vania Apkarian, Jane C. Ballantyne, Ann Berger, David Borsook, Wen G. Chen, John T. Farrar, Jennifer Haythornthwaite, Susan D. Horn, Michael J. Iadarola, Charles E. Inturrisi, Lixing Lao, Sean MacKey, Jianren Mao, Andrea Sawczuk, George R. Uhl, James Witter, Clifford J. Woolf, Jon Kar Zubieta, Yu Lin

Research output: Contribution to journalArticle

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, weaknesses, and potential synergism of traditional randomized placebo-controlled trial (RCT) and practice-based evidence (PBE) methodologies as means to acquire the clinical data necessary to develop validated personalized analgesic-prescribing algorithms are overviewed. Several predictive factors that might be incorporated into such algorithms are briefly discussed, including genetic factors, differences in brain structure and function, differences in neurotransmitter pathways, and patient phenotypic variables such as negative affect, sex, and pain sensitivity. Currently available research is insufficient to inform development of quantitative analgesic-prescribing algorithms. However, responder subtype analyses made practical by the large numbers of chronic pain patients in proposed collaborative PBE pain registries, in conjunction with follow-up validation RCTs, may eventually permit development of clinically useful analgesic-prescribing algorithms. Perspective: Current research is insufficient to base opioid analgesic prescribing on patient characteristics. Collaborative PBE studies in large, diverse pain patient samples in conjunction with follow-up RCTs may permit development of quantitative analgesic-prescribing algorithms that could optimize opioid analgesic effectiveness and mitigate risks of opioid-related abuse and mortality.

Original languageEnglish (US)
Pages (from-to)103-113
Number of pages11
JournalJournal of Pain
Volume14
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Precision Medicine
Chronic Pain
Opioid Analgesics
Analgesics
Evidence-Based Practice
Pain
Pain Management
Research
Analgesia
Neurotransmitter Agents
Registries
Randomized Controlled Trials
Placebos
Mortality
Brain

Keywords

  • chronic pain
  • opioid abuse
  • Opioid analgesics
  • personalized medicine
  • side effects

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Bruehl, S., Apkarian, A. V., Ballantyne, J. C., Berger, A., Borsook, D., Chen, W. G., ... Lin, Y. (2013). Personalized medicine and opioid analgesic prescribing for chronic pain: Opportunities and challenges. Journal of Pain, 14(2), 103-113. https://doi.org/10.1016/j.jpain.2012.10.016

Personalized medicine and opioid analgesic prescribing for chronic pain : Opportunities and challenges. / Bruehl, Stephen; Apkarian, A. Vania; Ballantyne, Jane C.; Berger, Ann; Borsook, David; Chen, Wen G.; Farrar, John T.; Haythornthwaite, Jennifer; Horn, Susan D.; Iadarola, Michael J.; Inturrisi, Charles E.; Lao, Lixing; MacKey, Sean; Mao, Jianren; Sawczuk, Andrea; Uhl, George R.; Witter, James; Woolf, Clifford J.; Zubieta, Jon Kar; Lin, Yu.

In: Journal of Pain, Vol. 14, No. 2, 02.2013, p. 103-113.

Research output: Contribution to journalArticle

Bruehl, S, Apkarian, AV, Ballantyne, JC, Berger, A, Borsook, D, Chen, WG, Farrar, JT, Haythornthwaite, J, Horn, SD, Iadarola, MJ, Inturrisi, CE, Lao, L, MacKey, S, Mao, J, Sawczuk, A, Uhl, GR, Witter, J, Woolf, CJ, Zubieta, JK & Lin, Y 2013, 'Personalized medicine and opioid analgesic prescribing for chronic pain: Opportunities and challenges', Journal of Pain, vol. 14, no. 2, pp. 103-113. https://doi.org/10.1016/j.jpain.2012.10.016
Bruehl, Stephen ; Apkarian, A. Vania ; Ballantyne, Jane C. ; Berger, Ann ; Borsook, David ; Chen, Wen G. ; Farrar, John T. ; Haythornthwaite, Jennifer ; Horn, Susan D. ; Iadarola, Michael J. ; Inturrisi, Charles E. ; Lao, Lixing ; MacKey, Sean ; Mao, Jianren ; Sawczuk, Andrea ; Uhl, George R. ; Witter, James ; Woolf, Clifford J. ; Zubieta, Jon Kar ; Lin, Yu. / Personalized medicine and opioid analgesic prescribing for chronic pain : Opportunities and challenges. In: Journal of Pain. 2013 ; Vol. 14, No. 2. pp. 103-113.
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