Genetics and Opioids: Towards More Appropriate Prescription in Cancer Pain

Bugada, Dario; Lorini, Ferdinando Luca; Allegri, Massimo

doi:10.3390/cancers12071951

Cited by 24 publications

(22 citation statements)

References 100 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Opioids are the therapeutic agents of choice to manage moderate to severe pain in patients with cancer in end-of-life 2 , however the unpredictable inter-individual response to opioid therapy remains a challenge for clinicians 1 . Pharmacogenetics has been shown to be a promising approach to tailor treatment to an individual’s genetic profile as cancer patients with a more favourable genetic background have been shown to respond better to opioids with a lower dose and fewer side effects 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Association of KCNJ6 rs2070995 and methadone response for pain management in advanced cancer at end-of-life

Ozberk

Haywood

Sutherland

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Opioids are the therapeutic agents of choice to manage moderate to severe pain in patients with advanced cancer, however the unpredictable inter-individual response to opioid therapy remains a challenge for clinicians. While studies are few, the KCNJ6 gene is a promising target for investigating genetic factors that contribute to pain and analgesia response. This is the first association study on polymorphisms in KCNJ6 and response to methadone for pain management in advanced cancer. Fifty-four adult patients with advanced cancer were recruited across two study sites in a prospective, open label, dose individualisation study. Significant associations have been previously shown for rs2070995 and opioid response in opioid substitution therapy for heroin addiction and studies in chronic pain, with mixed results seen in postoperative pain. In this study, no associations were shown for rs2070995 and methadone dose or pain score, consistent with other studies conducted in patients receiving opioids for pain in advanced cancer. There are many challenges in conducting studies in advanced cancer with significant attrition and small sample sizes, however it is hoped that the results of our study will contribute to the evidence base and allow for continued development of gene-drug dosing guidelines for clinicians.

show abstract

Section: Introductionmentioning

confidence: 99%

Association of KCNJ6 rs2070995 and methadone response for pain management in advanced cancer at end-of-life

Ozberk

Haywood

Sutherland

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…The AEs observed in the W-TENS group were mainly local cutaneous reactions (erythema, 5.5%) due to the TENS technique, while those observed in the WO group were systemic and well known (dry mouth: 1.8%; constipation: 12.7%; nausea: 10.9%; vomiting: 1.8%; dizziness: 5.5%; drowsiness: 7.3%; and pruritus: 3.6%) and limit their use and effectiveness in clinical practice. 57…”

Section: Discussionmentioning

confidence: 99%

Wearable transcutaneous electrical nerve stimulation (actiTENS®) is effective and safe for the treatment of knee osteoarthritis pain: a randomized controlled trial versus weak opioids

Maheu

Soriot-Thomas

Noël

et al. 2022

Therapeutic Advances in Musculoskeletal

View full text Add to dashboard Cite

Introduction: Despite their poor tolerance, especially in the elderly, weak opioids (WO) remain commonly prescribed for patients with knee osteoarthritis (KOA). We compared the efficacy and safety of a new wearable transcutaneous electrical nerve stimulation (W-TENS) device with WO for the treatment of moderate-to-severe, nociceptive KOA chronic pain. Methods: The study was a non-inferiority, multicentric, prospective, randomized, single-blind, controlled, 2-parallel groups Trial. A total of 110 patients with KOA were included (Kellgren-Lawrence radiographic grade ⩾2; American College of Rheumatology criteria), with chronic moderate-to-severe nociceptive pain (mean 8-day pain intensity (PI) ⩾ 4 on an 11-point numerical rating scale), in failure to non-opioid analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with neuropathic pain were excluded. The co-primary endpoints were mean PI at 3 months (M3) and number of potentially treatment-related adverse events (TRAEs). Secondary outcomes included Western Ontario MAC Master University function subscale (range, 0–68), additional pain and quality of life measures, and responder rates. Results: The non-inferiority of W-TENS was demonstrated in both the per protocol (PP) and intent-to-treat (ITT) populations. At M3, PI in PP population was 3.87 (2.12) compared with 4.66 (2.37) [delta: −0.79 (0.44); 95% CI (−1.65, 0.08)] in W-TENS and WO groups, respectively. A planned superiority analysis showed a significant superiority of W-TENS over WO on PI at M3 ( p = 0.0124). The number of TRAEs was significantly lower in the W-TENS group ( n = 7) than in the WO group ( n = 36) ( p < 0.001). Other secondary outcomes also favored W-TENS. Conclusion: W-TENS was more effective and better tolerated than WO in the treatment of chronic nociceptive KOA pain and offers an interesting non-pharmacological analgesic alternative in the management of KOA. Trial Registration: ClinicalTrials.gov: NCT03902340

show abstract

“…Education of prescribers has been reported in Australia and New Zealand as one of the main opioid stewardship measures (78%) currently implemented. Furthermore, increased education on the use of opioid-free anesthesia and personalised opioid prescribing may have a large potential to reduce opioid use and its related adverse events [ 15 , 16 , 17 ]. Ensuring hospitals have a policy on prescriber education for safe opioid prescribing would assist in minimising such variations of opioid prescribing being observed around the world.…”

Section: Discussionmentioning

confidence: 99%

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

et al. 2021

View full text Add to dashboard Cite

Objective: The objectives of this study are to describe opioid stewardship practices in hospitals being implemented globally, in addition to investigating the attitudes and perceptions of health professionals regarding opioid stewardship in the hospital setting. Methods: A survey was developed by the research team to ask about participants’ attitudes and perceptions regarding opioid stewardship practices. The survey was piloted for performance by five independent third-party healthcare professionals prior to being made available online, being hosted using Research Electronic Data Capture software, with invitations distributed by the International Pharmaceutical Federation (FIP). Descriptive analyses were used to describe the features of the study, and responses obtained from the survey were further categorised into subgroups separating answers relating to attitudes and perceptions, and policies and regulations. Results: Overall, there were 50 respondents from 18 countries, representing an 8% response rate from the FIP hospital pharmacy section mailing list. In total, 33/50 (66%) participants agreed opioids are overused nationally, with 22/49 (45%) agreeing they are overused at their workplace. Furthermore, 32/50 (64%) agreed the opioid crisis is a significant problem nationally, and 44/50 (88%) agreed opioid stewardship would reduce problems associated with the opioid crisis. Policies to educate providers about safe opioid prescribing were uncommon, not exhibited in 26/46 (57%) of hospitals, with all EMR and SE Asia hospitals not displaying this policy. Policy for investigation of narcotic discrepancies was present in 34/46 (74%) of hospitals, and there was a policy for reporting discrepancies at 33/46 (72%) hospitals. Conclusion: In conclusion, healthcare professionals in the American region are more likely to perceive the opioid crisis as a problem, as opposed to those from the European region. Regardless of the presence or absence of a crisis, the implementation of further opioid education and stewardship practices are necessary globally and will contribute to safer prescribing and utilisation practices in hospitals.

show abstract

Genetics and Opioids: Towards More Appropriate Prescription in Cancer Pain

Cited by 24 publications

References 100 publications

Association of KCNJ6 rs2070995 and methadone response for pain management in advanced cancer at end-of-life

Association of KCNJ6 rs2070995 and methadone response for pain management in advanced cancer at end-of-life

Wearable transcutaneous electrical nerve stimulation (actiTENS®) is effective and safe for the treatment of knee osteoarthritis pain: a randomized controlled trial versus weak opioids

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

Contact Info

Product

Resources

About