Personalized Pediatric Pain Management: Myth or Reality?

For a child undergoing a surgical procedure or issues with chronic pain, an essential goal is to obtain optimal pain management without significant adverse effects. Regretfully, safe and operative analgesia is an indefinable medical objective. Pain management within the pediatric realm reports that 50% pediatric perioperative pain experience will be efficient and acquire minimal side effects from opioids (Sadhasivam et al., 2014), It is well known that poor pain control can harvest physical difficulties, prolonged post-op recovery, and long-term behavioral complications. Still there is an extensive range of reactions to opioids secondary to variability in patient’s gender, ethnicity, development, co-morbidities and genetic factors. Research demonstrates that up to two-thirds of the unpredictability in pain perception and differences in the effectiveness of analgesic drugs are partly genetically predetermined (Cregg, et al., 2013).

Since the completion of the Human Genome and Hap Map Project the era of personalized medicine is upon us. Sequencing of the entire human genome has brought about a progression of knowledge regarding drug therapies, genetic predisposition and environmental impact such as epigenetics. Every individual has a distinctive genetic code. Pharmacogenomics is the study of how disparities in the human genome ultimately affect the response to medications and offer different views into the variability observed within individuals prescribed opioids for pain management (Jannetto & Bratanow, 2011). Pharmacogenomics seeks to link differences in gene structure or genotype (polymorphisms) with pharmacologic differences in drug action (phenotype) (Galinkin, et al, 2010). Pharmacogenomics primarily is split into two parts describing genetic variants involving pharmacokinetics (absorption, distribution, metabolism and elimination of a drug) and pharmacodynamics (an activity of the drug at the target site/receptor of a drug (Janicki, 2013; Jannetto & Bratanow, 2011).

Opioids are standard treatments for chronic and post-operative pain. Reports of prescription opiate misuse in adolescence and adult population is predominant in the media. The concern in healthcare providers and families is fear of exposure to prescribed opioid prescription drugs may be a catalyst for addiction Hence, pain pharmacogenomics has held promise to provide information on one’s genome , identify patients at risk for complications or inadequate response to pain pharmacotherapy . The purpose of this presentation is to explore the genetic science involved with drug and individual variability which can aid nurses to support patient/families in developing guidelines towards a personalized pain management plan based upon one's genome.