2.50
Hdl Handle:
http://hdl.handle.net/10755/616107
Category:
Full-text
Type:
Presentation
Title:
Translational Genomics for Predicting Pediatric Pain Outcomes
Other Titles:
Pain-Omics Across the Lifespan
Author(s):
Manworren, Renee
Lead Author STTI Affiliation:
Mu
Author Details:
Renee Manworren, APRN-BC, PCNS-BC, FAAN, Rmanworren@connecticutchildrens.org
Abstract:
Session presented on Thursday, July 21, 2016: Purpose: Explore the potential for translating our emerging knowledge of genetic associations with pain sensitivity and analgesic metabolism to a personalized medicine approach to pediatric pain management. Methods: Candidate genes from two groups of pediatric patients were interrogated for associations with pain sensitivity and analgesic efficacy phenotypes. Candidate genes were selected based on previously identified associations with altered pain sensitivity in experimental pain and clinical pain syndromes (COMT, FKBP5, GCH1, OPRM1, OPRD1, TRPA1, TRPV1) and with altered analgesic metabolism (CYP2D6, CYP2C9, CYP2C19, CYP3A4, CYP3A5). Individual variability in pain experiences, use of opioids and opioid effectiveness will be illustrated. Patients with chronic pain (N=19) complicated by analgesic inefficacy and adverse analgesic effects were retrospectively tested for CYP2D6, CY2C19 & CYP2C9 genetic variants. Subsequently, (N=60) adolescents? post-operative pain after posterior spinal fusion for idiopathic scoliosis or thoracoscopic repair of pectus excavatum was prospectively studied for genetic associations with both genetic variants in pain sensitivity and analgesic metabolism.Results: Significant CYP2D6 genetic variants were identified in 84% of the chronic pain patients: 4 were ultra-rapid metabolizers, 8 deficient metabolizers, 3 poor metabolizers and 1 a null metabolizer. Of the three patients with functional CYP2D6 status, two were CYP2C19 null metabolizers. It is predicted that pediatric patients with alleles associated with high pain sensitivity would report more severe pain intensity, require more opioid analgesics, and experience more analgesic adverse effects; but the interaction of genetic variation in pain sensitivity and alterations in analgesic metabolism may critically influence and explain variability in individual pain experiences. Conclusion: The high prevalence of severe pain after surgery, potential for long-term pain and adverse effects of analgesics highlights the need for better predictors and strategies to treat both acute and chronic pediatric pain. If we can preemptively identify patients at greatest risk for pain and adverse analgesic effects, we can recommend: 1) against truly elective surgical procedures to correct non-life threatening or life-limiting anomalies, or 2) treatment with genetically suitable analgesics. Other potential translations include opioid addiction risk modeling. Further research is needed to integrate pharmacogenetic and clinical findings into anticipatory guidance for genetic testing and analgesic prescribing to children with pain.
Keywords:
pharmacogenetics; pain management; personalized medicine
Repository Posting Date:
13-Jul-2016
Date of Publication:
13-Jul-2016 ; 13-Jul-2016
Other Identifiers:
INRC16B01; INRC16B01
Conference Date:
2016
Conference Name:
27th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Cape Town, South Africa
Description:
Theme: Leading Global Research: Advancing Practice, Advocacy, and Policy

Full metadata record

DC FieldValue Language
dc.language.isoenen
dc.type.categoryFull-texten
dc.typePresentationen
dc.titleTranslational Genomics for Predicting Pediatric Pain Outcomesen
dc.title.alternativePain-Omics Across the Lifespanen
dc.contributor.authorManworren, Reneeen
dc.contributor.departmentMuen
dc.author.detailsRenee Manworren, APRN-BC, PCNS-BC, FAAN, Rmanworren@connecticutchildrens.orgen
dc.identifier.urihttp://hdl.handle.net/10755/616107-
dc.description.abstractSession presented on Thursday, July 21, 2016: Purpose: Explore the potential for translating our emerging knowledge of genetic associations with pain sensitivity and analgesic metabolism to a personalized medicine approach to pediatric pain management. Methods: Candidate genes from two groups of pediatric patients were interrogated for associations with pain sensitivity and analgesic efficacy phenotypes. Candidate genes were selected based on previously identified associations with altered pain sensitivity in experimental pain and clinical pain syndromes (COMT, FKBP5, GCH1, OPRM1, OPRD1, TRPA1, TRPV1) and with altered analgesic metabolism (CYP2D6, CYP2C9, CYP2C19, CYP3A4, CYP3A5). Individual variability in pain experiences, use of opioids and opioid effectiveness will be illustrated. Patients with chronic pain (N=19) complicated by analgesic inefficacy and adverse analgesic effects were retrospectively tested for CYP2D6, CY2C19 & CYP2C9 genetic variants. Subsequently, (N=60) adolescents? post-operative pain after posterior spinal fusion for idiopathic scoliosis or thoracoscopic repair of pectus excavatum was prospectively studied for genetic associations with both genetic variants in pain sensitivity and analgesic metabolism.Results: Significant CYP2D6 genetic variants were identified in 84% of the chronic pain patients: 4 were ultra-rapid metabolizers, 8 deficient metabolizers, 3 poor metabolizers and 1 a null metabolizer. Of the three patients with functional CYP2D6 status, two were CYP2C19 null metabolizers. It is predicted that pediatric patients with alleles associated with high pain sensitivity would report more severe pain intensity, require more opioid analgesics, and experience more analgesic adverse effects; but the interaction of genetic variation in pain sensitivity and alterations in analgesic metabolism may critically influence and explain variability in individual pain experiences. Conclusion: The high prevalence of severe pain after surgery, potential for long-term pain and adverse effects of analgesics highlights the need for better predictors and strategies to treat both acute and chronic pediatric pain. If we can preemptively identify patients at greatest risk for pain and adverse analgesic effects, we can recommend: 1) against truly elective surgical procedures to correct non-life threatening or life-limiting anomalies, or 2) treatment with genetically suitable analgesics. Other potential translations include opioid addiction risk modeling. Further research is needed to integrate pharmacogenetic and clinical findings into anticipatory guidance for genetic testing and analgesic prescribing to children with pain.en
dc.subjectpharmacogeneticsen
dc.subjectpain managementen
dc.subjectpersonalized medicineen
dc.date.available2016-07-13T11:04:34Z-
dc.date.issued2016-07-13-
dc.date.issued2016-07-13en
dc.date.accessioned2016-07-13T11:04:34Z-
dc.conference.date2016en
dc.conference.name27th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationCape Town, South Africaen
dc.descriptionTheme: Leading Global Research: Advancing Practice, Advocacy, and Policyen
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