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Updated: Jul 29, 2025

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Pharmacogenetic Analysis Enables Optimization of Pain Therapy: A Case Report of Ineffective Oxycodone Therapy

Florine M Wiss1,2, Céline K Stäuble1,2,3, Henriette E Meyer Zu Schwabedissen3

  • 1Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland.

Journal of Personalized Medicine
|May 27, 2023
PubMed

Insights

Pharmacogenetic testing can personalize pain management. Genetic analysis revealed why a patient poorly responded to certain analgesics, guiding a switch to more effective medications like hydromorphone and paracetamol.

Area of Science:

  • Pharmacogenomics
  • Pain Management
  • Clinical Pharmacology

Background:

  • Individual responses to analgesics vary significantly, with some patients experiencing insufficient pain relief or adverse side effects.
  • Pharmacogenetic testing is underutilized in analgesic therapy, despite genetic variants influencing responses to opioids, non-opioid analgesics, and antidepressants for neuropathic pain.

Observation:

  • A patient with chronic pain from a disc hernia showed poor response to oxycodone, fentanyl, and morphine, with a history of NSAID-induced side effects.
  • Pharmacogenotyping revealed decreased cytochrome P450 2D6 (CYP2D6) activity, increased CYP3A activity, and impaired µ-opioid receptor response, explaining opioid ineffectiveness.
  • Reduced CYP2C9 activity indicated slowed ibuprofen metabolism, increasing gastrointestinal side effect risk.

Findings:

  • Genetic variants in CYP2D6, CYP3A, and the µ-opioid receptor contributed to the patient's inadequate response to common opioid analgesics.
  • CYP2C9 genetic variations predisposed the patient to gastrointestinal side effects from NSAIDs like ibuprofen.
  • Pharmacogenetic analysis identified hydromorphone and paracetamol as suitable alternatives due to unaffected metabolic pathways.

Implications:

  • Pharmacogenetic analysis can elucidate medication ineffectiveness and poor tolerability in complex chronic pain syndromes.
  • Integrating genetic information into medication reviews can optimize analgesic selection and improve patient outcomes.
  • This case highlights the potential of personalized pharmacogenomic approaches for managing chronic pain effectively.
Keywords:
CYP2C9CYP2D6CYP3Aadverse drug reactionanalgesicsoxycodonepain therapypharmacogeneticstherapy failure

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