BACKGROUND:Pain clinicians have always been challenged by the variability of response to pain treatment. Differences in the degree of pain stimulation and pain sensitivity, weight and age differences, prior opioid use and tolerance, as well as the differences in bioavailability of various opioid formulations have been cited as causes for the wide variability in analgesia seen with opioids. Genetics may explain the variability of responses and help to predict more effective (or less dangerous) medication choices and doses. Genetics may also help to predict the response to specific opioids and antidepressants. OBJECTIVES:In this review article, we discuss the genetic influence of nociception, analgesia, and hyoanalgesia. The CYP450 enzymes involved in the metabolism and activity of opioids and adjuvant analgesics are genetically controlled, as are the opioid receptors and a variety of brain chemistries. METHODS:This article discusses the specific pain implications of genetic variations in CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4, CYP3A7, OPRM1, OPRK1, OPRD1, COMT, GABA, UGT, MC1R, GCH1, ABCB1, P-glycoprotein, 5HTR1A, 5HTR2A, MTHFR, CACNA2D2, and 5-HTTLPR. RESULTS:Recent research findings suggest the relationship between genetic predisposition and clinical behavior, including the risk of opioid misuse and addiction. While urine drug testing may hint at genetic issues regarding opioid metabolism, cheek swab DNA testing has become economically viable, and we review the current and future genetic pain issues that may influence the decisions that pain clinicians make every day. CONCLUSION:Genetic testing may explain and predict many of the clinical responses seen with opioids and adjuvant medications, and may help the clinician identify those patients at genetic risk of opioid misuse and addiction.

译文

背景:疼痛临床医生一直受到对疼痛治疗反应的可变性的挑战。疼痛刺激和疼痛敏感性程度的差异,体重和年龄的差异,先前使用阿片类药物和耐受性的差异以及各种阿片类药物制剂的生物利用度差异被认为是阿片类药物镇痛广泛差异的原因。遗传学可以解释反应的变异性,并有助于预测更有效(或更危险)的药物选择和剂量。遗传学也可能有助于预测对特定阿片类药物和抗抑郁药的反应。
目的:在这篇综述文章中,我们讨论了伤害感受,镇痛和镇痛的遗传影响。涉及阿片类药物和辅助镇痛药的代谢和活性的CYP450酶,阿片受体和各种脑化学物质均受到基因控制。
方法:本文讨论CYP1A2,CYP2C8,CYP2C9,CYP2C19,CYP2D6,CYP2E1,CYP3A4,CYP3A7,OPRM1,OPRK1,OPRD1,COMT,GABA,UGT,MC1R,G1蛋白的遗传变异对特定疼痛的影响,5HTR1A,5HTR2A,MTHFR,CACNA2D2和5-HTTLPR。
结果:最近的研究结果表明遗传易感性与临床行为之间的关系,包括阿片类药物滥用和成瘾的风险。虽然尿液药物检测可能提示有关阿片类药物代谢的遗传问题,但颊拭子DNA检测已在经济上可行,我们将回顾当前和未来的遗传性疼痛问题,这些问题可能会影响临床医生每天做出的决定。
结论:基因检测可以解释和预测使用阿片类药物和辅助药物所见的许多临床反应,并可以帮助临床医生识别出有阿片类药物滥用和成瘾的遗传风险的患者。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录