Integrating genetic insights into pain management and opioid use optimization in chronic pain and substance abuse populations

Introduction

Chronic pain affects approximately 20 % of adults worldwide, impacting over 1.5 billion individuals and placing a significant burden on both patients and healthcare systemssubstantial. The ongoing opioid epidemic has further complicated treatment, with approximately 80,000 opioid-related overdose deaths in the United States in 2023 alone, alongside worsening substance use disorder (SUD).¹ Clinicians face the difficult challenge of balancing effective pain relief with minimizing the risks of misuse and addiction. Traditional pain management often relies on trial-and-error approaches, leading to suboptimal outcomes, adverse drug events (ADEs), and increased healthcare costs.

A paradigm shift is urgently needed to deliver safer, more effective, and individualized pain management, particularly for vulnerable populations, such as those living with both chronic pain and SUD, amid recent FDA initiatives to expand non-opioid options and curb misuse. Pharmacogenomics (PGx), the study of how genetic variation influences drug response, offers a promising solution.² By identifying genetic factors that affect drug metabolism and efficacy, PGx can guide more precise prescribing decisions, improve treatment safety and enhance outcomes. Ultimately, PGx has the potential to transform pain management while simultaneously addressing the intertwined challenges of chronic pain and SUD.

In the United States, chronic pain prevalence has surged post-pandemic, affecting roughly 50 million adults who report pain on most days or every day. PGx integrates with other omics technologies, such as proteomics and metabolomics, for a more holistic approach to precision medicine in pain management.

This paper explores PGx in pain management, opioid stewardship, and SUD, the pharmacist’s role, challenges, and future directions, before concluding with implications for practice.