American Society of Regional Anesthesia and Pain Medicine May 2017 - 22

specificity in distinguishing neuropathic versus nociceptive LBP
was more than 90%. They demonstrated a pain assessment tool
independent of disease etiology based on symptoms and signs.9
Careful phenotyping of cases can identify subgroups of patients
with the same etiology. Personalized pain treatment is in its
infancy, but we are advancing. Phenotyping is a clinical tool that
can identify underlying pathophysiological mechanisms and
guide individualized treatment options. Although genetic testing
currently cannot be used to predict and diagnose chronic pain,
we can use this information to better treat patients with painful
conditions and reduce the process of trial and error that is often
frustrating for both physicians and patients. The hope for the future
is that genotyping, along with phenotyping, can personalize and
individualize pain therapy and improve patient care.
REFERENCES
1.

22
2

Wanscher JH. The history of Wilhelm Johannsen's genetic terms and concepts
from the period 1903 to 1926. Centaurus 1975; 19 (2): 125-147.

2.

Edwards RR. Genetic predictors of acute and chronic pain. Curr Rheumatol Rep.
2008;8:411-417.

3.

Onojighofia T. Perception of analgesia in narcotic users with chronic pain: a
multi center cross sectional study comparing genotype to Pain VAS (P.A.I.N.
study). PAIN Week: American Academy of Neurology 2014 Meeting, Las Vegas,
Nevada. P4.349 2014.

4.

MTUS: Medical Treatment Utilization Schedule: chronic pain medical treatment
guidelines. 2009.

5.

Indiana University School of Medicine. P450 Drug Interactions: Abbreviated
"Clinically Relevant" Table, Substrates. Available at: http://medicine.iupui.edu/
clinpharm/DDIs/ClinicalTable.aspx. Accessed March 2017.

6.

Oesterheld J. Cytochrome P 450 (CYP) Metabolism Reference Table. Seattle, WA:
Genelex; 2012; Available at: http://youscript.com/healthcare-professionals/whyyouscript/cytochrome-p450-drug-table/. Accessed March 2017.

7.

Tennant F, Hocum B. Pharmacogentics and pain management: clinical use and
interpretation of the common pharmacogentics tests. Practic Pain Manage.
2015;15(7):64.

8.

Nickel JC, Shoskes D. Phenotypic approach to the management of chronic
prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2009;10:307-312.

9.

Scholz J, Mannion RJ, Hord DE, et al. A novel tool for the assessment of pain:
validation in low back pain. PLoS Med. 2009;6(4):e1000047.

American Society of Regional Anesthesia and Pain Medicine
2017


http://medicine.iupui.edu/clinpharm/DDIs/ClinicalTable.aspx http://medicine.iupui.edu/clinpharm/DDIs/ClinicalTable.aspx http://www.youscript.com/healthcare-professionals/why-youscript/cytochrome-p450-drug-table/ http://www.youscript.com/healthcare-professionals/why-youscript/cytochrome-p450-drug-table/

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