• Chrysanthi Batistaki, Eleni Chrona, Andreas Kostroglou, Georgia Kostopanagiotou, and Maria Gazouli.
• 2nd Department of Anaesthesiology, Faculty of Medicine, National, Kapodistrian University of Athens, Pain Management Unit, "Attikon" Hospital, Athens, Greece.
• Pain Med. 2020 Nov 1; 21 (11): 3199-3204.

ObjectiveTo assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine.DesignProspective cohort study.SettingGeneral hospital, pain management unit.SubjectsPatients with chronic pain, treated with codeine or tramadol.MethodsPatients' pain was assessed at baseline (numeric rating scale [NRS]; 0-10). Prescription of codeine or tramadol was selected randomly. The assessment of patients' response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of >50% or an NRS <4 was considered a positive response. Patients' blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]).ResultsSeventy-six consecutive patients were studied (20 males, 56 females), aged 21-85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]).ConclusionsGenotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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