Pharmacogenomic factors may not predict opioid use after TKA vs. psychosocial factors
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Key takeaways:
- Pharmacogenomic factors were not predictive of pain or opioid use after TKA.
- Preoperatively assessed psychosocial variables may be more accurate predictors of pain or opioid use for these patients.
Compared with an analysis of psychosocial variables, pharmacogenomic factors were not predictive of pain or opioid use after total knee arthroplasty, according to published results.
To analyze the association between phenotype gene variation and opioid use after orthopedic surgery, Richard L. Wixson, MD, and colleagues performed a prospective, observational study of 305 patients who underwent elective TKA between May 12, 2019, and Oct. 17, 2022.
According to the study, Wixon and colleagues performed pharmacogenomic testing on three genes involved in the opioid pathway and pain modulation: CYP2D6, COMT and OPRM1. They analyzed outcomes such as Patient-Reported Outcomes Measurement Information System (PROMIS)-43 scores, VAS pain scores and opioid use for 30 days after surgery.
Researchers found a significant relationship between COMT phenotype groups and adequate pain control (VAS pain score of 4 or less) compared with uncontrolled pain (VAS pain score greater than 4). However, they found no other relationships between any phenotype variations of CYP2D6, COMT and OPRM1 with pain or opioid use. After multiple logistic regression, researchers found PROMIS-43 domains of pain interference and anxiety were significantly associated with pain and opioid use.
Wixon and colleagues concluded that preoperatively assessed psychosocial variables may be more accurate predictors of pain or opioid use for patients who undergo TKA compared with pharmacogenomic factors.
Perspective
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Optimizing pain control and enhancing recovery following total knee replacement surgery is complex and multifactorial. TKR has traditionally been one of the most painful surgeries within medicine, leading to 10% to 15% of patients continuing to take narcotics well past 1 year from surgery. While TKR has made significant improvements in the past 5 to 10 years, such as same-day surgery, we must continue efforts to improve pain management after the patient leaves the hospital. Improved understanding of patient-specific factors that contribute to pain is one important component to improving our outcomes.
Unfortunately, there is no single variable or solution to achieve the best outcome. The surgeon must optimize patient-, surgeon- and hospital-specific factors to provide the best possible outcomes for each patient.
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