A Pain in the Neck – or Elsewhere: No Laughing Matter

Posted by Sara Carpenter on Jun 29, 2020 2:21:42 PM
Sara Carpenter
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Aside from the pun “a pain in the neck,” pain is no laughing matter. In fact, chronic pain ranks among the most common reasons adults seek medical care, making chronic pain management a major issue for physicians.

According to 2016 data analyzed by the Center for Disease Control and Prevention (CDC), 50 million Americans – 20.4% of the U.S. population – suffer from chronic pain, defined as pain that is ongoing and lasts more than six months. And, the National Center for Complementary and Integrative Health reports that 11 million Americans – 8% of the population – suffer from high-impact chronic pain that has lasted more than 3 months and restricted their work outside the home, impacted school attendance or impeded the performance of household chores. Notably, in the United States, one in five patients seen by a clinician for pain receives a prescription for opioids. As a result, chronic pain carries with it negative consequences for the suffering individuals, as well as their families, friends and coworkers. The argument could be made that chronic pain also impacts communities, cities and our nation as a whole. 

Underneath the Pain

Every patient metabolizes and responds differently to any given ingestible drug and also has unique factors that impact their metabolism and response to that drug. These factors collectively impact drug efficacy. Among the factors are cytochrome P450 enzymes, a class of enzymes with more than 50 enzymes required to metabolize medications.  

Here’s where it gets even more complicated.

  • Of the 50 enzymes in the cytochrome P450 (CYP 450) enzyme class, six of them – CYP1A2, CYP2C9, CYP2C19, CYP3A5, CYP3A4 and CYP2D6, the latter two of which are the most significant – metabolize 90% of all drugs.

  • These same enzymes can be inhibited or induced by a drug, sparking drug-drug interactions that lead to adverse reactions or therapeutic failures.

  • Cytochrome P450 enzymes are often involved in drug interactions with statins, antidepressants, anti-epileptic drugs and anticoagulants.

  • Enzyme genetic variability, or polymorphism, also can influence how a patient responds to drug classes, including commonly prescribed classes of antidepressants and beta blockers.

 Every person’s genotype for CYP 450 enzymes determines whether that individual is a poor, intermediate, extensive or rapid metabolizer of drugs. A person who is one of the two extremes – poor or rapid metabolizer – is prone to drug toxicity or lower effectiveness of medications.

Jumping the Genetic Hurdles

Since genetics account for 20-90% variability in the absorption, distribution, metabolism, excretion and effects of over-the-counter and prescription medications, it’s critical for physicians to pinpoint a patient’s unique sensitivities and determine how they will respond to a specific medication or combination of medicines.

Doing so can be accomplished through a simple pharmacogenetic test that provides a win/win for physicians and patients alike. Physicians aren’t challenged with uncertain trial-and-error dosing, and patients aren’t burdened with potentially adverse drug incidents, which can be dangerous, frightening and life-threatening.

The case for pharmacogenetics is further supported by these startling statistics associated with prescription drug medications: About one in 15 patients will experience an adverse drug reaction, and ≈1 in 300 patients will have a fatal adverse drug reaction.

Combining pharmacology and genomics, the science of pharmacogenetics studies the role of the genome in drug response.

Clinical evidence and resources that provide guidance to clinicians on the use of pharmacogenetic information for select gene–drug pairs are increasing. These resources include pharmacogenetic data within the United States FDA labeling for nearly 200 medications and the availability of curated and ranked clinical pharmacogenetic evidence summaries in the Pharmacogenomics Knowledge Base. Additionally, clinical guidelines that provide consensus recommendations on genotype-informed drug dosing are available for 35 drugs or drug classes from the Clinical Pharmacogenetics Implementation Consortium (CPIC), an international consortium. Recommendations from CPIC are available for CYP2D6-guided therapy for codeine and tramadol; however, the evidence for hydrocodone and oxycodone are less strong. Of other available treatment options for pain management, CYP2D6 and CYP2C19 for tricyclic antidepressants, CYP2D6-venlafaxine, CYP2C9-celecoxib and CYP2B6-methadone have the best CPIC level. These recommendations suggest avoidance of the use of some drugs or reduction of dose when the patients are determined to be poor, intermediate, normal or rapid metabolizers of drugs based on the results of their pharmacogenetic testing.

Using Science for Solutions

PGx Testing offered by Diax Labs is a unique pharmacogenetics solution for potentially life-saving personalized patient care.


A simple saliva test for PGx Testing uses a patient’s genes for science-based decision-making. 

  • Identify unique sensitivities to potential drug effects

  • Determine response to a particular medicine

  • Predict potential drug-drug interactions

  • Develop a science-based treatment plan

  • Provide precision medicine tailored to a patient’s genetics


Test results are accurate and expeditious, generally reported within a window of two to 10 days, resulting in a reporting period significantly outpacing many labs with six-week turnaround times.


Healthcare professionals frequently utilize Diax Labs’ PGx Testing for a patient with one or more of these common issues.

  • An effective medication has been difficult to pinpoint

  • A very high dosage of a medication has been required

  • An unusual or very expensive medication regimen has been prescribed

  • A family history of adverse drug reactions exists

  • A new medication is being added to the treatment plan

  • Plavix (clopidogrel) is being prescribed

  • A drug metabolized by the CYP450 enzyme is being taken

  • A drug that stimulates or inhibits CYP450 is being taken

  • Multiple prescription medications are being taken

Key Takeaways

Pharmacogenetics is a science for understanding how a patient’s DNA influences drug treatment outcomes.  

√ Pharmacogenetic testing provides healthcare providers with valuable genetic information that can improve patient health.

√ Findings from pharmacogenetics testing replaces the paradigm of one-dose-fits-all dosing. 

Pharmacogenetic testing is an important proactive component of many patient treatment plans.

Here to Assist You

Are you an independent physician or laboratory marketing professional that sells to independent physicians?

We welcome the opportunity to talk with you about Diax Labs’ PGx Testing for chronic pain management. To learn more or to schedule a virtual presentation, please click Learn More below.


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Topics: Blog