First report of pharmacogenomic profiling in an outpatient spine setting: preliminary results from a pilot study.

Abstract Objective Pharmacogenomics may help personalize medicine and improve therapeutic selection. This is the first study investigating how pharmacogenomic testing may inform analgesic selection in patients with spine pathology. We sought to profile pharmacogenetic differences in pain-medication–metabolizing enzymes across patients presenting to an outpatient spine clinic, and offer provide preliminary evidence that genetic polymorphisms may help explain inter-patient differences in preoperative pain refractory to conservative management. Methods Adults presenting to our outpatient spine clinic with chief complaints of neck and/or back pain were prospectively enrolled over 9 months. Patients completed the Wong-Baker FACES and Numerical Pain Rating Scales for their chief pain complaint, and provided detailed medication histories, and cheek swab samples for genomic analysis. Results Thirty adults were included (mean age: 60.6±15.3 years). Chief concern was neck pain in 23%, back pain in 67%, and combined neck/back pain in 10%. At enrollment, patient analgesic regimens comprised 3±1 unique medications, including 1±1 opioids. After genomic analysis, 14/30 patients (47%) were identified as suboptimal metabolizers of ≥1 medications in their analgesic regimen. Of these, 93% were suboptimal metabolizers of their prescribed opioid analgesic. Nonetheless, pain scores were similar between optimal and suboptimal metabolizer groups. Conclusions This pilot study demonstrates that a large proportion of the spine outpatient population may be using pain medications for which they are suboptimal metabolizers. Further studies should assess whether these pharmacogenomic differences translate to differences in odds of receiving therapeutic benefit from surgery, or if they can be used to generate more effective postoperative analgesic regimens.