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Genetic Loci Linked to Level of Pain Medication Management Needed

Researchers have identified a handful of genetic loci associated with switching from non-opioid analgesics to opioids in the management of chronic musculoskeletal pain. Treatment typically begins along a three-step ladder with a non-opioid analgesic, then to a weak opioid for mild-to-moderate pain and possibly to a strong opioid for severe pain, but there are many differences between patients, including genetic ones, that could influence the level of medication they need. As they report in the Pharmacogenomics Journal, researchers from Radboud University Medical Center in the Netherlands conducted a genome-wide association study of about 23,000 people from the UK Biobank to find one loci significantly associated with switching from non-opioid analgesics to opioids to manage pain and seven suggestive loci. Four genes implicated by these loci have been tied to neuropathic pain processes or musculoskeletal development, and further network analysis implicated EGFR, though the researchers caution that the input into that analysis consists of nominally significant genes and "should be interpreted carefully." They add that their analysis, which show "a small genetic contribution to analgesic ladder switching," is "an initial stepping stone for future research."