Pharmacotherapy, which remains the cornerstone of chronic pain management, includes analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs), the more potent opioids, and adjunct therapies such as antidepressants and anticonvulsants. It is well-recognized that interindividual differences exist in the general population in terms of pain perception, response to analgesic treatment, and toxicities experienced.
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The new millennium has brought about the promise of genomics for the understanding of disease and the advancement of therapeutic approaches.1 The scientific community has continued to establish the genetic basis of phenotypic variability among individuals and ethnic groups in terms of susceptibility to disease as well as response to therapy.
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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.
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As I have discussed in previous perspectives, the human and economic toll of opioid abuse and misuse is unacceptably high. A multifaceted approach to this serious public health problem is essential and should involve all stakeholders. One emerging area of focus for the effective management of chronic pain is the role of pharmacogenomics and genetic profiling in patient selection and prescribing.
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