Pharmacogenomic testing in pain medicine

Pharmacogenomics (PGx) in Pain Medicine – Benefits of Personalized Prescribing

Prescribing can often be particularly challenging for pain management specialists, since chronic pain sufferers are often being treated for other conditions, such as depression, addiction or cancer. One of the fundamental goals of pain management is better control of pain without significant adverse effects from pain medications themselves.

Unfortunately, safe and effective analgesia is an important unmet critical medical need and its continued existence is an important clinical, economic and societal problem. This is mainly because of huge and unpredictable interpatient variability and narrow therapeutic indices of currently used medications. Opioids are some of the most commonly used analgesics. Narrow therapeutic index and large interpatient variability in response to opioids are clinically significant, with inadequate pain relief at one end of the spectrum and serious side effects, such as respiratory depression and excessive sedation due to relative overdosing, at the other end.

Personalizing pain management attempts to maximize pain relief, while minimizing adverse events from therapy. While various factors influence response to treatment, age, sex, race and pharmacogenetic differences appear to play major roles in predicting outcome. Genetic factors include a subset of genes that modulate the proteins involved in pain perception, pain pathway, analgesic metabolism (pharmacokinetics), transport and receptor signaling (pharmacodynamics). We have reviewed the available evidence on improving and personalizing pain management with opioids and the significance of individualizing analgesia, in order to maximize analgesic effect with minimal adverse effects with opioids.

The ACLSalgos™ can help prescribers improve pain management by determining each patient’s unique drug metabolizing capacity and identifying which drugs and doses are likely to be most effective in treating their pain.

Until recently, pain management specialists had little choice, but to prescribe medications without knowing in advance how patients might respond. Today, ACLSalgos™ makes it possible for physicians to know, before they prescribe, which medications will be most effective based on individual genetic profiles – and which ones will not.

What is included in this test bundle:


Urine drug testing is an important tool in the pain management setting. It provides important objective information, which assists physicians with the diagnosis and treatment decision-making process.


The ACLSalgos OFT is a comprehensive oral fluid test designed to be administered in the office of Pain Management Practitioners. It is an easy test that can be administered in the office under supervision, which removes the risk of sample adulteration.1


Pharmacogenomic testing in the setting of pain management provides a personalized approach to treatment. One of the fundamental goals in the pain management is to optimize treatment with better control of pain without significant adverse effects from medications for all patients.

ACLSalgos™ is designed to:

  • Evaluate patient genetic variability that could potentially deem a particular drug ineffective.
  • Determine appropriate therapy for each patient, based on their genetic variability.
  • Evaluate potential drug-drug interactions and susceptibility of each patient.
  • Improve informed consent by communicating current and future therapy trends specifically engineered for each individual.

The goal of personalized pain management is the most effective and individualized balance at which a patient experiences maximum desirable analgesic relief and minimal undesirable adverse effects. ACLSalgos™ testing is the foundation of personalized medicine and it will help us select the right drug at the right dose, for the right patient.

Common Pain Medications with Pharmacogenetic Information

Drug (CYP)Biomarker
Codeine2D6, 3A4
Fentanyl 3A4
Hydrocodone2D6, 3A4
Methadone2B6, 2D6, 3A4
Oxycodone2D6, 3A4
Tramadol2D6, 3A4

ACLSalgos™ Helps You Achieve Optimal Prescribing

Many opioid analgesics are metabolized into a much more active metabolite by CYP2D6 or CYP3A4, and many non-steroidal anti-inflammatory drugs (NSAIDs) are metabolized by CYP2C9. Genetic variations in these cytochromes are extremely common. This genetic variability is often the most important consideration in how an individual patient will respond to a medication.

ACLSalgos™ tests for all clinically significant genetic variants in the enzymes responsible for metabolizing the majority of medications: CYP2D6, CYP2C9, CYP2C19, CYP3A4, CYP3A5, CYP2B6, COMT, CYP1A2 and OPRM1.