Methods and compositions for personalized pain management

1. A method for treating a patient in need of analgesia, the method comprising

determining the patient's genotype utilizing a method comprising one or more of a polymerase chain reaction (PCR), gel electrophoresis, mass spectrometry, and array hybridization for at least one genetic variant selected from the group consisting of ABCB1 rs9282564, ABCC3 rs4148412, and ABCC3 kgp8560677,

assigning the patient into one of two risk groups defined as low risk and high risk for a serious opioid-induced adverse event,

wherein the patient is assigned into either the high risk group or the low risk group based upon the patient's genotype for the at least one genetic variant such that the patient is assigned to the high risk group if the patient has at least one high risk genotype for the at least one genetic variant and the patient is assigned to the low risk group if the patient lacks any high risk genotypes,

wherein the high risk genotypes are defined as follows:

ABCB1 rs9282564, a genotype of either GG or AG is high risk for respiratory depression [RD];

ABCC3 rs4148412, a genotype of either AA or AG is high risk for prolonged stay in recovery due to RD [prolongRD]; and

ABCC3 kgp8560677, a genotype of either AA or AG is high risk group for post-operative nausea and vomiting [PONV],

and

administering to the patient assigned to the high risk group a non-morphine opioid or a non-opioid analgesic; or administering to the patient assigned to the low risk group any one of a non-morphine opioid analgesic, a non-opioid analgesic, an opioid analgesic other than morphine, or morphine.

2. The method of claim 1 , wherein the at least one genetic variant further comprises at least one additional variant selected from the group consisting of OPRM1 rs1799971, FAAH rs 324420, and ABCB1 rs1045642.

3. The method of claim 2 , wherein the high risk genotypes are defined for each of the at least one additional variants as follows:

OPRM1 rs1799971, a genotype of either GG or AG is high risk for [RD];

FAAH rs324420, a genotype of either AA or AC is high risk for [PONV]; and

ABCB1 rs1045642, a genotype of either TT or TC is high risk for [RD].

4. The method of claim 1 , wherein the PONV is refractory.

5. The method of claim 1 , wherein the assigning is performed by a computer implemented method.

6. The method of claim 5 , wherein the computer implemented method comprises a decision rule.

7. The method of claim 5 , wherein the computer implemented method comprises encoding the genotypes such that each genetic variant gives rise to two coupled binary variables.

8. The method of claim 6 , wherein the decision rule comprises

IF [(rs9282564=AA) OR (rs4148412=GG) OR (kgp8560677=GG)] THEN RISK=NO (low)

ELSE RISK=YES (high).

9. The method of claim 1 , wherein at least one additional non-genetic factor is utilized to refine the assignment of the patient into one of the two risk groups or to select a dose of the medication.

10. The method of claim 9 , wherein the at least one additional non-genetic factor is selected from gender, race, age, and diagnosis.

11. The method of claim 10 , wherein the patient is a female pediatric patient of Caucasian ancestry assigned to the low risk group, and the opioid analgesic is administered such that the total dose does not exceed 0.15 mg/kg, 0.2 mg/kg, or 0.275 mg/kg.

12. The method of claim 1 , wherein the patient is a pediatric patient.

13. The method of claim 1 , wherein the patient is of Caucasian ancestry.

14. The method of claim 1 , wherein the patient's genotype is received directly from equipment used in determining the patient's genotype.

15. The method of claim 1 , wherein the patient's genotype is determined by a method comprising obtaining or receiving a biological sample from the patient, extracting DNA from the sample, and analyzing the DNA to determine the patient's genotype at each genetic variant in the panel.

16. The method of claim 15 , wherein the DNA is analyzed using a polymerase chain reaction based genotyping platform.

17. The method of claim 16 , wherein the genotyping platform utilizes a 5′ nuclease assay for amplifying and detecting specific genetic variants.

18. The method of claim 15 , wherein the biological sample is selected from a blood sample and a buccal swab.

19. The method of claim 1 , wherein the non-opioid analgesic is selected from the group consisting of paracetamol and a non-steroidal anti-inflammatory drug (NSAID).

20. The method of claim 1 , wherein the the opioid analgesic other than morphine is selected from the group consisting of fentanyl, hydromorphone, codeine, oxycodone, hydrocodone, tramadol, ondansetron, dexamethasone, methadone, alfentanil, and remifentanil.

21. The method of claim 1 , wherein the method comprises administering to the patient assigned to the low risk group either an opioid analgesic other than morphine, or morphine.

22. The method of claim 21 , wherein the the opioid analgesic other than morphine is selected from the group consisting of fentanyl, hydromorphone, codeine, oxycodone, hydrocodone, tramadol, ondansetron, dexamethasone, methadone, alfentanil, and remifentanil.