scholarly journals A Review of the Role of Genetic Testing in Pain Medicine

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 425-445 ◽  
Author(s):  
Andrea M. Trescot
Keyword(s):  
Genetic Testing ◽  
Opioid Receptors ◽  
Drug Testing ◽  
Pain Treatment ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Key Words Genetics ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Wide Variability

Background: Pain clinicians have always been challenged by the variability of response to pain treatment. Differences in the degree of pain stimulation and pain sensitivity, weight and age differences, prior opioid use and tolerance, as well as the differences in bioavailability of various opioid formulations have been cited as causes for the wide variability in analgesia seen with opioids. Genetics may explain the variability of responses and help to predict more effective (or less dangerous) medication choices and doses. Genetics may also help to predict the response to specific opioids and antidepressants. Objectives: In this review article, we discuss the genetic influence of nociception, analgesia, and hyoanalgesia. The CYP450 enzymes involved in the metabolism and activity of opioids and adjuvant analgesics are genetically controlled, as are the opioid receptors and a variety of brain chemistries. Methods: This article discusses the specific pain implications of genetic variations in CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4, CYP3A7, OPRM1, OPRK1, OPRD1, COMT, GABA, UGT, MC1R, GCH1, ABCB1, P-glycoprotein, 5HTR1A, 5HTR2A, MTHFR, CACNA2D2, and 5-HTTLPR. Results: Recent research findings suggest the relationship between genetic predisposition and clinical behavior, including the risk of opioid misuse and addiction. While urine drug testing may hint at genetic issues regarding opioid metabolism, cheek swab DNA testing has become economically viable, and we review the current and future genetic pain issues that may influence the decisions that pain clinicians make every day. Conclusion: Genetic testing may explain and predict many of the clinical responses seen with opioids and adjuvant medications, and may help the clinician identify those patients at genetic risk of opioid misuse and addiction. Key words: Genetics, genetic testing, opioid metabolism, drug interactions, urine drug testing, opioid risk evaluation, opioid receptors

Systematic urine drug testing for detecting and managing opioid misuse among chronic noncancer pain patients in primary care—The HARMS Program: A retrospective chart review of 77 patients

2020 ◽  
Vol 16 (4) ◽  
pp. 277-282
Author(s):  
Niharika Shahi, HBSc ◽  
Ryan Patchett-Marble, BSc, MD, CCFP(AM)
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Drug Testing ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Noncancer Pain

The prevalence of opioid abuse has reached an epidemic level. National guidelines recommend safer opioid prescribing practices, including potentially monitoring patients with urine drug testing (UDT). There is limited research evidence surrounding the use of UDT in the context of chronic noncancer pain (CNCP). We evaluated the efficacy of systematic, randomized UDT to detect and manage opioid misuse among patients with CNCP in primary care. The Marathon Family Health Team (MFHT) designed and implemented a clinic-wide, randomized UDT program called the HARMS (High-yield Approach to Risk Mitigation and Safety) Program. This retrospective chart review includes 77 CNCP patients being prescribed opioids, who were initially stratified by their prescriber as “low-risk.” Each month, 10 percent of patients were selected for a random UDT with double testing (immunoassay and liquid chromatography-mass spectrometry). The primary outcome measure was UDT leading to a change in management plan. Of the 77 patients in the study, 55 (71 percent) completed at least one UDT during the 12-month study period. Overall, 22 patients had aberrant results. UDT led directly to changes in management in 15 of those patients. Four of those 15 patients were escalated to an addictions program, two were tapered from opioids with informed discussion, and nine were escalated to the high-risk monitoring stream. The results of this study show that in low-risk CNCP patients prescribed opioids, applying systematic UDT in a primary care setting is effective for detecting high risk behaviors and addiction, and altering management. Further research is needed with larger numbers using a prospective study design.

scholarly journals Urine Drug Testing of Chronic Pain Patients. III. Normetabolites as Biomarkers of Synthetic Opioid Use

2010 ◽  
Vol 34 (8) ◽  
pp. 444-449 ◽  
Author(s):  
A. DePriest ◽  
R. Heltsley ◽  
D. L. Black ◽  
B. Cawthon ◽  
T. Robert ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

Random versus targeted urine drug testing among cancer patients receiving opioid therapy at a supportive care clinic.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 221-221
Author(s):  
Joseph Anthony Arthur ◽  
Zhanni Lu ◽  
David Hui ◽  
Kristy Nguyen ◽  
Bernard Lobato Prado ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Random Group ◽  
Care Clinic ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Abnormal Results

221 Background: Although urine drug testing (UDT) is an effective risk monitoring tool for patients on chronic opioid therapy, there is currently no evidence to guide physicians in identifying who should have UDT, or when and how often it should be ordered. The main objective of our study was to describe the characteristics of patients who underwent random UDT and a similar cohort who underwent targeted UDT. Methods: Demographic and clinical information of 212 patients who underwent random UDT was retrospectively reviewed and compared with 88 patients who underwent targeted UDT. Targeted UDT was ordered based on the physician’s estimation of patient risk for nonmedical opioid use. All patients were eligible for random UDT regardless of their risk potential for nonmedical opioid use. Results: 212/231 (92%) eligible patients underwent random UDT. Of these 59 (28%) had abnormal results. Among 64 abnormalities detected, 14 (20%) were prescribed opioids that were absent from the urine, 19 (30%) were unprescribed opioids that were present, and 32 (50%) were illicit drugs (91% marijuana). 38/88(43%) of targeted patients had abnormal results. Among 49 abnormalities detected, 13 (27%) were prescribed opioids that were absent from the urine, 15 (31%) were unprescribed opioids that were absent, and 21 (43%) were illicit drugs (71% marijuana). UDT abnormalities were significantly higher in the targeted group than the random group (43.2% vs. 27.8%, p=0.01). There were no significant differences in demographic and clinical characteristics between random and targeted patients with abnormal UDT findings. UDT abnormality was independently associated with age (OR= 0.97 per year, 95% CI: 0.95-0.99, p=0.012), female gender (OR=0.47, 95% CI: 0.28-0.81, p=0.006), anxiety (OR=1.11per point, 95% CI: 1.01-1.22, p=0.039), and appetite (OR= 1.14 per point, 95% CI: 1.04-1.26, p=0.006). Conclusions: More than 1 in 4 cancer patients who underwent random UDT had abnormal results. UDT abnormality in randomly selected patients were no different from targeted patients. Further studies are needed to guide clinical practice regarding standardization of UDT ordering among patients with cancer.

Urine drug testing for patients on buprenorphine: Informative beyond self-reported cocaine and opioid use?

2017 ◽  
Vol 171 ◽  
pp. e13
Author(s):  
Sarah Mary Bagley ◽  
Debbie M. Cheng ◽  
Michael R. Winter ◽  
Dan Alford ◽  
Colleen Labelle ◽  
...  
Keyword(s):  
Drug Testing ◽  
Opioid Use ◽  
Urine Drug Testing ◽  
Urine Drug

Aberrant Opioid Use and Urine Drug Testing in Outpatient Palliative Care

2016 ◽  
Vol 19 (7) ◽  
pp. 778-782 ◽  
Author(s):  
Joseph A. Arthur ◽  
Ali Haider ◽  
Tonya Edwards ◽  
Jessica Waletich-Flemming ◽  
Suresh Reddy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Drug Testing ◽  
Opioid Use ◽  
Urine Drug Testing ◽  
Urine Drug

Analytical and technical aspects of testing for drug abuse: confirmatory procedures.

1988 ◽  
Vol 34 (3) ◽  
pp. 471-473 ◽  
Author(s):  
M A Peat
Keyword(s):  
Drug Testing ◽  
Analytical Procedure ◽  
Gas Chromatography Mass Spectrometry ◽  
Technical Aspects ◽  
Governmental Agencies ◽  
Accuracy And Precision ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chemical Technique ◽  
Layer Chromatography

Abstract Many laboratories are now performing urine drug testing for employers, governmental agencies, and other institutions. It is now recognized that presumptive positive screening results have to be confirmed by an analytical procedure based on a different chemical technique with greater than or equal sensitivity to the screening test. Thin-layer chromatography has been widely used for this; however, it is relatively insensitive for certain drugs, and it cannot satisfy the accuracy and precision requirements needed to determine threshold concentrations reliably. Gas chromatography-mass spectrometry is able to satisfy these threshold requirements and has become the method of choice for confirming initial immunoassay results.

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