• Ethan Cottrill, Zach Pennington, A Karim Ahmed, Bowen Jiang, Jeff Ehresman, Alex Zhu, Alexander Perdomo-Pantoja, Daniel Lubelski, Daniel M Sciubba, Timothy Witham, Kevin MacDonald, Chun Hin Lee, Lai Chun Wan Jeffrey CWJ Advanced Genomic Solutions (AGS) Ltd., Scottsdale, Arizona, USA., and Nicholas Theodore.
• Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
• World Neurosurg. 2021 Jan 1; 145: e21-e31.

ObjectivePharmacogenomics 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 disease. We profile pharmacogenetic differences in pain medication-metabolizing enzymes across patients presenting at an outpatient spine clinic and provide preliminary evidence that genetic polymorphisms may help explain interpatient differences in preoperative pain refractory to conservative management.MethodsAdults presenting to our outpatient spine clinic with chief symptoms of neck and/or back pain were prospectively enrolled over 9 months. Patients completed the Wong-Baker FACES and numeric pain rating scales for their chief pain symptom and provided detailed medication histories and cheek swab samples for genomic analysis.ResultsThirty adults were included (mean age, 60.6 ± 15.3 years). The 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 patients, 93% were suboptimal metabolizers of their prescribed opioid analgesic. Nonetheless, pain scores were similar between optimal and suboptimal metabolizer groups.ConclusionsThis pilot study shows that a large proportion of the spine outpatient population may use pain medications for which they are suboptimal metabolizers. Further studies should assess whether these pharmacogenomic differences indicate differences in odds of receiving therapeutic benefit from surgery or if they can be used to generate more effective postoperative analgesic regimens.Copyright © 2020 Elsevier Inc. All rights reserved.

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