How Genes Influence Your Pain — And How You Can Control Them
A Cleveland Clinic pain specialist explains the genetics of pain and how pharmacogenomics could help physicians in prescribing pain meds.
More than 200 genes are involved in the way we process pain. And in recent years, research has been ramping up to better understand the genetics of pain.
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“We have learned from twin studies looking at migraine headaches, chronic low back pain and menstrual pain that heredity is a contributor to how we experience and process pain,” says pain management specialist Teresa Dews, MD.
Dr. Dews says the influence of heredity on the pain experience can be as high as 60 percent. But just because you inherited genes for a certain pain response, doesn’t mean you will experience the pain. It is environmental factors that trigger that response.
“You may have a group of genes associated with having a certain pain or pain condition, but you can keep them ‘turned off’ with good choices,” says Dr. Dews. “It’s about how you interact with your genes, which are influenced by diet, external toxins, trauma and injury, stress and lack of sleep. You have a big part in keeping these genes silent by practicing good habits.”
As a pain physician, Dr. Dews knows that most people will experience some pain in their lives, due to injuries, aging or poor habits. When working with patients, her goal is to find the best therapies or medications for each individual’s pain.
“There is so much variance in how people experience pain,” says Dr. Dews. “Some patients react to everything. There is a range of how people process medications from ultra-metabolizers – or fast metabolizers – to hypo-metabolizers – or slow metabolizers.”
Being able to distinguish which end of the spectrum patients are on could help in determining the best medications to use for treatment. Dr. Dews says some patients are fast metabolizers, which can make them resistant to pain meds or give them more side effects at normal doses. Depending on the drug, fast metabolizers may break down the medication before it has a chance to reach the blood level needed to ease the pain.
Pharmacogenomics is the study of how genes affect a person’s response to drugs. It is a relatively new field that combines the study of genes (genomics) and the science of drugs (pharmacology) to develop effective and safe medications that can be customized for a person’s genetic makeup.
“With proven pharmacogenomics, we could better understand how a person metabolizes medications. This would improve our choices for pain medications and potentially decrease side effects or poor response to treatment,” she says. “Today, we look at family history and use trial and error, going from one medication to another, until we learn what works. Pharmacogenomics could change this.”
Dr. Dews cautions that pharmacogenomics is still in its infancy. There are a lot of companies out there today that are offering genetic testing direct to consumers. These companies say they can provide people with information on the type of medication metabolizers they are, but Dr. Dews says there are concerns about how accurate and valid this information is.
“Pharmacogenomics has definite potential for helping to manage patients’ pain and decrease drug reactions,” says Dr. Dews. “But people need to know that more research needs to be done to find ways to apply this testing to clinical practice.”
Before pursuing testing by a company, talk to your physician.