Catechol-O-Methyltransferase Polymorphisms Predict Opioid Consumption in Postoperative Pain

Candiotti, Keith A.; Yang, Zhe; Buric, David; Arheart, Kris; Zhang, Yanping; Rodriguez, Yiliam; Gitlin, Melvin C.; Carvalho, Enisa M.; Jaraba, Isabel; Wang, Liyong

doi:10.1213/ane.0000000000000411

Cited by 56 publications

(40 citation statements)

References 18 publications

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“…Various clinical studies have demonstrated that the required dose of morphine is higher in subjects with a COMT G/G genotype, compared with other genotypes, in cancer and non-cancer pain (11)(12)(13)(14). The current findings are consistent with these results.…”

Section: Discussionsupporting

confidence: 90%

“…In these studies, patients with the G/G genotype received the highest dose of morphine (11,12), while those with the A/A genotype received the lowest morphine dose (13). However, the majority of these studies had a small sample size, were retrospective, or were targeting non-cancer pain (14). A large sample study has indicated that none of the 112 single nucleotide polymorphisms (SNPs) in 25 candidate genes demonstrated significant associations with opioid dose (15); however, the quantity of concomitant analgesics [non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen] and the method for dose determination of opioids remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Prospective replication study implicates the catechol-O-methyltransferase Val158Met polymorphism as a biomarker for the response to morphine in patients with cancer

et al. 2017

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Prospective replication study implicates the catechol-O-methyltransferase Val158Met polymorphism as a biomarker for the response to morphine in patients with cancer

et al. 2017

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“…Our results are also consistent with Candiotti and colleagues, who reported that individuals with the Val/Val genotype needed 36% more opioids than patients homozygous for the Met/Met group ( p = 0.009). However, they did not find significant differences among the three genotype groups for pain scores or emesis medication use in the first 24 h after surgery (Candiotti et al, 2014). …”

Section: Discussionmentioning

confidence: 95%

Exploring the multifactorial nature of postoperative nausea and vomiting in women following surgery for breast cancer

Wesmiller

Sereika

Bender

et al. 2017

Autonomic Neuroscience

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Background Postoperative nausea and vomiting (PONV) are two of the most frequent and distressing complications following surgical procedures, with as many as 80% of patients considered to be at risk. Despite recognition of well-established risk factors and the subsequent use of clinical guidelines, 20–30% of women do not respond to antiemetic protocols, indicating that there may be a genetic risk. Objective The purpose of this pilot study was to describe the incidence and explore the risk factors associated with PONV after surgery in women diagnosed with early stage breast cancer. Methods A prospective cohort design was employed to measure PONV in women recruited prior to surgery. DNA was extracted from saliva samples collected prior to discharge. Polymorphisms for seven candidate genes with a known role in one of the neural pathways associated with PONV were included in this study; serotonin receptor (HTR3A), serotonin transport (SLC6A4), tryptophan (TPH), dopamine receptors (DRD2/ANKK and DRD3), catechol-O-methyltransferase (COMT) and histamine (H1). Results Twenty-nine (29.8%) women experienced nausea and 10 (11%) experienced nausea and vomiting while in the PACU despite administration of multiple antiemetic medications. Women who experienced PONV had higher levels of pain and received more opioids than those women who did not experienced PONV. Odds ratios demonstrated that alleles for the COMT, DRD3, and TPH genes were associated with decreased PONV. Conclusion The understanding of the multifactorial nature of PONV and the recognition of genetic risk will ultimately lead to the development of personalized interventions to manage these frequent and often debilitating symptoms.

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“…Genetic factors can also impact postoperative analgesic responses, which may impact CPSP since acute pain severity is among the strongest predictors of CPSP. In addition to multiple genes that impact drug metabolism [144], COMT [29,36] and OPRM1 [80,152] have been associated with postoperative opioid analgesic requirements.…”

Section: General Considerationsmentioning

confidence: 99%

Research design considerations for chronic pain prevention clinical trials

Gewandter

Dworkin

Turk

et al. 2015

Pain

130

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Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (i.e., chronic post-surgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (i.e., surgery, viral infection, injury, and toxic/noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

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Catechol-O-Methyltransferase Polymorphisms Predict Opioid Consumption in Postoperative Pain

Abstract: The genetic variant of the COMT rs4680 single nucleotide polymorphism is associated with variability in opioid consumption in postoperative nephrectomy patients. The COMT rs4818 polymorphism may prove useful in predicting emesis medication use postoperatively.

Cited by 56 publications

References 18 publications

Prospective replication study implicates the catechol-O-methyltransferase Val158Met polymorphism as a biomarker for the response to morphine in patients with cancer

Prospective replication study implicates the catechol-O-methyltransferase Val158Met polymorphism as a biomarker for the response to morphine in patients with cancer

Exploring the multifactorial nature of postoperative nausea and vomiting in women following surgery for breast cancer

Research design considerations for chronic pain prevention clinical trials

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