Ask a Pharmacist: Pharmacogenomic Testing for Pain Management (February 26th, 2018)



  • Awesome. Thank you Bryce and Derek for taking the time to be part of the live forum today. Our discussion has offered great insight for anyone interested in exploring pharmacogenomic testing further.



  • This has been great! Thanks for all the questions and for having us today!



  • Coming from the BC Pharmacy Association I'd just like to mention that there are now approximately 80 pharmacies in BC who are offering pharmacogenomic testing! So the technology is becoming more and more accessible to patients in BC.

    If anyone has any more questions for me i can be reached at bryce.wong@rxome.ca



  • Great! is there anything else we haven't covered that you think those considering pharmacogenomic testing should know?



  • At the same time it's likely that we will continue to see advancements in pharmacogenomic applications in areas like mental health, pain, oncology etc.



  • I think the next big step for pharmacogenomics is to make it more mainstream in clinical care.

    Right now there are a number of studies occurring in Canada looking to add to the body of evidence around the application of pharmacogenomics. Ideally this research and the progress of private companies will help to drive the uptake of the technology by both patients and healthcare professionals and get private and public payers really looking to pay for it as part of routine care.



  • Clearwater asked a question above: What's on the horizon for this kind of testing? Is there research being done to improve it? What can we expect in the next few years?



  • Most definitely



  • What's on the horizon for this kind of testing? Is there research being done to improve it? What can we expect in the next few years?



  • Is pharmagocenomic testing under a process of continuous improvement then, as researchers learn more about genes and variations?



  • If done by an accredited laboratory following international standards the result of a pharmacogenomic test are accurate.

    However, testing can be limited in terms of what genes and how many variants of a gene they analyze and this is where it can get a little confusing. Some gene variants may occur with greater frequency in certain ethnicities than others. At the same time just a variant has been identified doesn't mean we know how it impacts drug response.

    Bottom line is i think that most pharmacogenomic tests will look at the variations of a gene that occur most frequently and for which there is enough evidence to generate clinical recommendations.



  • A community member asked: "how accurate is pharmacogenomic testing really? is the accuracy the same across all people and genes?"



  • Although it would be great if everyone was tested, because there is an out of pocket expense right now one may want to consider how it will impact them today. So for people who are taking medications and have experienced issues with harmful side effects or lack of effect, they might find the most value in being tested right now.

    Having said that having your test results prior to getting a new prescription can also be valuable in terms of avoiding potential side effects and wasting time and money on treatments that may not be ideally suited to you. But, since we often can't predict when we'll need medications this is where individuals will have to decide if they think it's worth having this information ahead of time.



  • So should everyone be doing this kind of testing? How should a person decide it it's worth it?



  • Good question - again this may vary from company to company, so something important to ask when considering your testing options. Usually this should be outlined in the patient consent form.



  • Another question from social: "Are patient results used in any other way than to inform their individualized pain management?"



  • Well the testing itself only analyzes genes, not drugs. So if there is a lack of scientific evidence that links having a certain gene variant with response to certain drugs, then testing will not be able to provide any recommendations regardless of the test result. As well, if a drug is not metabolized in the body by enzymes/proteins which are coded for by the genes than testing will generally not be able to provide any recommendations for that drug.



  • Are you aware of any common pain medications for which pharmacogenomic testing CANNOT be done?



  • Some common medications used to treat pain with pharmacogenomic linkages include: codeine, tramadol, oxycodone, hydrocodone, celecoxib, amitriptyline, nortriptyline, duloxetine.



  • What are some of the common pain meds that this kind of testing can be used for?


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