Pharmacogenomics in acute pain

Key genes and polymorphic phenotypic variants involved in nociception, responses to acute pain, to analgesic drugs and development of chronic pain, are profiled. Genetic polymorphisms, gender dependence and ethnicity regulating expression, or function of ion channels, homeostasis of biogenic amines, opioids, enzymes, growth factors or tyrosine kinases, are reviewed in pain pathology and determinants of drug response. Variable responses to opioids are important for safety and effective pain relief. These are attributable to environmental factors or heterogeneity in genotypes/phenotypes impacting on pharmacodynamics, pharmacokinetics/absorption, distribution, metabolism, and excretion (ADME) or both. Increased understanding of basic science with low cost genotyping/phenotyping (personalising therapy to individuals or ethnic groups) has potential to impact on outcomes in peri-operative/post-traumatic acute pain and persistent pain, and on safety of potent analgesics.