The role of pharmacogenomics in effective pain management with opioids.

Opioids are commonly prescribed as standards of care for various types of pain. Multiple pathways can impact pain response, and understanding medication metabolism is imperative to achieving optimal analgesic response. Pharmacogenomics (PGx) can assist with understanding interindividual variability and aid in safe medication prescribing. Genetic variants in pharmacokinetic and pharmacodynamic genes have been evaluated, and literature generally favors use of pharmacokinetic associations in clinical practice. Tramadol and codeine have the most literature to support integration of PGx into routine prescribing practices. Hydrocodone and oxycodone have theoretical implications; however, data have been inconsistent. Clinical decision support has been the mainstay of integration of PGx results into routine clinical practice. Future research should focus on additional pathways implicated in opioid metabolism and response to further guide effective pain management with opioids.