Over the last few years, there has been increasing emphasis on medicines optimisation and developing personalised medicine. Personalised medicine aims to choose medicine types and dosages for individual patients based upon genetic, biomarker and other patient-related factors. Personalised medicine has advanced significantly and is being applied routinely in some specialties, particularly oncology, however, personalisation of analgesic medicines is not new. In the late 1980s, the influence of polymorphisms in the cytochrome P450 2D6 enzyme system on codeine metabolism was first reported, and patients were able to be classified as either ‘poor’ or ‘ultra-rapid’ metabolisers. Even with the explosion in genomic technology and improved diagnostic testing, testing for CYP450 2D6 phenotype is uncommon in clinical practice.
This issue of the British Journal of Pain (BJP) includes a service evaluation by Johnson et al.1 which identified that 8% of referral letters did not even contain information about current analgesics and 20% did not contain information about other medicines. Around a one-fifth of patients were at risk of suboptimal analgesic response or developing side effects due to interaction with other medicines metabolised by the CYP450 2D6 isoenzyme.
Perhaps one of the reasons why personalised medicine has been so difficult to apply in pain medicine is the complex interaction between many physiological, psychological, social and cultural components.
One the other hand, medicines optimisation is about ensuring that the right patient receives the right choice of medicine, at the right time. It aims to be a patientfocused approach to ensure optimal use of medicines and requires a holistic approach with an enhanced level of patient-centred professionalism and improved partnership between healthcare professionals and a patient. There are four key principles to medicines optimisation: aim to understand the patient’s experience, evidence- based choice of medicines, ensure medicines use is as safe as possible and make medicines optimisation part of routine practice. We know that many of the analgesic medicines available do not work for most patients but exploring the patient experience offers us the opportunity to understand their concerns and worries.
Will personalised medicine become a reality in pain medicine? One day possibly, however, there are many more basic issues regarding expectations and beliefs about analgesic medicines that we need to address on a daily basis to ensure patients are obtaining the most from the analgesic medicines that they are taking.
Roger Knaggs
Deputy Editor
Reference
- 1. Radford H, Fitzgerald P, Martin S, et al. A service improvement project to review prescribing information provided by general practitioners for new referrals to a UK National Health Service hospital pain clinic. Br J Pain 2016; 10: 222-231. [DOI] [PMC free article] [PubMed] [Google Scholar]