Why Is My Patient Still in Pain?

Faculty Perspectives in Chronic Pain:Utilizing Pharmacogenomics When Selecting Personalized Medicine for Patients with Chronic Pain - Faculty Perspectives
Atheer A. Kaddis, PharmD

As pharmacists and caregivers, we have all experienced situations in which patients and loved ones continue to experience pain after being treated with proven, advanced analgesics. It leads us to question whether the correct dose was administered, whether the appropriate diagnosis was made, and even whether some other physiologic or psychologic condition is involved. We have also questioned why some individuals respond very well to certain analgesics, whereas others have limited or no response to the same medication at the same dose. We are now learning more about the impact of pharmacogenomics on the effectiveness and safety of medications, including analgesic agents used for the treatment of chronic pain.

In the main article of this publication, the author provides an overview of the various genetic factors that may affect the safety and efficacy of commonly used analgesics. The topics discussed include the importance of cytochrome P450 enzymes, uridine diphosphate glucuronosyltransferases, P-glycoprotein–mediated drug transport, opioid receptors, and catechol-O-methyltransferase for the management of chronic pain. This provides important insight into the influence of pharmacogenomics on chronic pain management.

Pharmacogenomics is the study of genetic differences that are responsible for the variability in response to drugs and metabolism among individual patients.1 The goal of this research is to provide valuable information for personalized medicine—that is, giving a patient the right medicine at the right dose. Although pharmacogenomics should allow pharmaceutical companies to develop safer, more effective drugs,1 many challenges still remain. These include the lack of rapid, automated genome analysis for all individuals, the need for a greater understanding of the genes involved in disease and drug interactions, and the complexity of the disease.1 This last point is a very important one and is also the greatest challenge in the field of pharmacogenomics. Even with the identification of various genes, transport mechanisms, and receptors that impact the safety and effectiveness of analgesics used for chronic pain, we still do not fully understand why some patients react differently from others to the same agents delivered at the same doses.

The latest thinking is that both genetic and nongenetic factors influence a patient’s response to specific therapies.2 This hypothesis has been published with respect to anti-inflammatory agents2 but can probably be extrapolated to analgesics as well. For example, genetic variants among individuals may ultimately determine a patient’s clinical response to a particular treatment.2 The broad consensus is that additional research needs to be conducted to answer the question, “Why is my patient still in pain?” In the interim, it is up to us as healthcare professionals to provide the best care possible and to promote additional research so that this perplexing question can finally be answered.


  1. Gosavi DD, Pawar GJ. Pharmacogenomics: promises and challenges. Int J Res Pharm Biomed Sci. 2011;2:1444-1448.
  2. Maranville JC, Di Rienzo A. Combining genetic and nongenetic biomarkers to realize the promise of pharmacogenomics for inflammatory diseases. Pharmacogenomics. 2014;15:1931-1940.
Related Items
Association Between Formulary Coverage and Use of Abuse-Deterrent Prescription Opioids, Risk for Abuse or Overdose, and Associated Healthcare Resource Utilization
Allison Petrilla, MPH, Elizabeth Marrett, MPH, Xian Shen, PhD, MS, BS, Winghan Jacqueline Kwong, PharmD, PhD, Edmund Pezalla, MD, MPH
February 2020 Vol 13, No 1 published on February 18, 2020 in Business, Original Research
Rate of Adverse Events and Healthcare Costs Associated with the Topical Treatment of Rosacea
Todd Williamson, PhD, MSc, Rajesh Kamalakar, MS, Augustina Ogbonnaya, MPH, Erin A. Zagadailov, PharmD, MS, Michael Eaddy, PharmD, PhD, Charlie Kreilick, MBA
May 2017 Vol 10, No 3 published on May 16, 2017 in Clinical, Original Research
Effects of Specialty Pharmacy Care on Health Outcomes in Multiple Sclerosis
Jun Tang, PhD, James Bailey, MD, MPH, Cyril Chang, PhD, Richard Faris, PhD, Song Hee Hong, PhD, Michael Levin, MD, Junling Wang, PhD
November 2016 Vol 9, No 8 published on November 16, 2016 in Business
Patient Characteristics and Prescribing Patterns Associated with Sofosbuvir Treatment for Chronic HCV Infection in a Commercially Insured Population
Brent M. Tambourine, PharmD, BCPS, Arash Sadeghi, PharmD, Jianing Yang, MD, MS, Karen M. Stockl, PharmD, Heidi C. Lew, PharmD, Brian K. Solow, MD, FAAFP, Josephine N. Tran, PharmD, MS
April 2016 Vol 9, No 2 published on April 19, 2016 in Clinical
Coping with Agitation Associated with Schizophrenia and Bipolar Disorder: How Can Healthcare Professionals Help Their Patients?
Beverly Barton, PhD
Faculty Perspectives: Coping with Agitation Associated with Schizophrenia and Bipolar Disorder: How Can Healthcare Professionals Help Their Patients? published on January 8, 2016 in Faculty Perspectives
Last modified: February 4, 2016
Copyright © Engage Healthcare Communications, LLC. All rights reserved.