Genomics and Precision Analgesia: Is this the era?
Vol 6 | Issue 1 | January-June 2025 | Page 15-19 | Bhuvaneswari Balasubramanian, Sandeep Diwan
DOI: https://doi.org/10.13107/ijra.2025.v06.i01.116
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted: 24-02-2025; Reviewed: 19-03-2025; Accepted: 19-05-2025; Published: 10-06-2025
Authors: Bhuvaneswari Balasubramanian [1]
Sandeep Diwan [2]
[1] Department of Anaesthesiology & Critical Care, AIIMS, Nagpur, Maharashtra, India.
[2] Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
Address of Correspondence
Dr. Bhuvaneswari Balasubramanian
Department of Anaesthesiology & Critical Care, AIIMS, Nagpur, Maharashtra, India.
Email: docbhuvaneswari@gmail.com
Abstract
Interindividual variability in analgesic response reflects heritable differences in drug metabolism, receptor expression, neurotransmitter turnover, and central nervous system drug transport. Pharmacogenomic advances have clarified functional consequences of polymorphisms in CYP2D6, CYP3A4, UGT2B7, OPRM1, COMT, and ABCB1, each of which influences opioid and non-opioid pharmacokinetics and pharmacodynamics. CYP2D6 metabolizer status determines conversion of prodrugs such as codeine and tramadol to active metabolites, while CYP3A4 variation modulates systemic opioid clearance. OPRM1 A118G alters μ-opioid receptor binding affinity and signaling, COMT Val158Met influences catecholamine-mediated pain sensitivity, and ABCB1 variants affect opioid penetration across the blood–brain barrier. Clinical studies demonstrate genotype-associated differences in analgesic efficacy and toxicity, though effect sizes vary across populations and analgesic classes. Implementation remains constrained by limited genotype-stratified randomized trials, testing turnaround time, unclear cost-effectiveness, and underrepresentation of Asian and Southeast Asian ancestry groups in genomic datasets. This mini-review synthesizes mechanistic foundations, clinical evidence, population variation, and practical considerations for integrating pharmacogenomics into perioperative and chronic pain management.
Keywords: Genomics, Pharmacogenetics, Precision medicine, Analgesia, CYP2D6, Postoperative pain, Opioids
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| How to Cite this Article: Balasubramanian B, Diwan S. Genomics and Precision Analgesia – Is This the Era? International Journal of Regional Anaesthesia. January-June 2025; 6(1): 15-19. DOI: https://doi.org/10.13107/ijra.2025.v06.i01.116 |
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