Personalized pain management and anesthesia: preemptive risk identification and therapeutic decision support
Methods and compositions disclosed herein generally relate to methods of improving clinical and economic outcomes to address adverse effects related to anesthesia, analgesics, opioids, and inadequate pain relief. Embodiments of the invention relate to the association between genes, specific polymorphisms of genes, and non-genetic factors with inadequate pain relief and anesthesia-, analgesic, and/or opioid-related adverse effects. Embodiments of the invention can be used to determine and manage patient risk factors for development of adverse perioperative effects and can allow for personalized anesthesia and pain management for improvement of pain control and reduction of anesthesia-, analgesic-, and opioid-related adverse outcomes. These methods and compositions apply to non-surgical pain management with opioids. Therefore, patients who are genetically predisposed to risk of inadequate pain relief and/or serious side effects from anesthesia, analgesics, and/or opioids can be identified and individualized treatment plans developed for implementation by the clinician to improve clinical and economic outcomes.
1. A method for treating a human patient for post-operative pain, the method comprising the steps of
a) obtaining a biological sample from a patient in need of treatment for post-operative pain, wherein the biological sample is obtained prior to administering an opioid analgesic to the patient,
b) genotyping the biological sample from the patient to determine the patient's haplotype at four single nucleotide polymorphisms (SNPs) of the organic cation transporter 1 (OCT1) gene identified by rs12208357, rs34130495, rs72552763, and rs34059508, wherein the genotyping is performed using one or more of a PCR-based technique for nucleic acid amplification from the sample, gel electrophoresis, mass spectrometry, and microarray hybridization,
c) assigning an OCT1 haplotype of *1, *2, *3, *4, or *5 based on the patient's genotype at each of the four SNPs as follows
rs12208357
rs34130495
rs72552763
rs34059508
286C > T
1306G > A
1365GAT > del
1498G > C
*1
Arg
Gly
Met
Gly
*2
Arg
Gly
del
Gly
*3
Cys
Gly
Met
Gly
*4
Arg
Ser
Met
Gly
*5
Arg
Gly
del
Arg
assigning the patient to Group 0, 1, or 2 based on the patient's haplotype as follows:
Group 0: *1/*1
Group 1: *1/*2, *1/*3, *1/*4, or *1/*5
Group 2: *2/*2, *2/*3, *2/*4, *2/*5, *3/*3, *3/*4, *3/*5, *4/*4, *4/*5, or *5/*5, and
d) administering fentanyl, hydromorphone, codeine, oxycodone, hydrocodone, tramadol, ondansetron, dexamethasone, methadone, alfentanil, remifentanil, acetaminophen, a non-steroidal anti-inflammatory drug (NSAID), dexmedetomidine, or clonidine, to the patient assigned to Group 2 in step c), or
e) administering morphine to the patient assigned to Group 0 or 1 in step c).
2. The method of claim 1 , wherein the patient is a pediatric patient.
3. The method of claim 1 , further comprising receiving at least one non-genetic risk factor selected from the patient's race, sex, and obstructive sleep apnea disease status.
4. The method of claim 3 , wherein the non-genetic risk factor is race and the race is selected from Caucasian and African American.
5. The method of claim 4 , wherein the race is Caucasian.