Pain management could become part of personalized medicine.
Advancements in science and technology are the reasons medical care has evolved over the years. Researchers and physicians are now working towards providing personalized medicine to more effectively meet a patient’s needs. The progress made in genetic testing will allow providers to treat illnesses and injuries better than before.
“Personalized medicine is really looking at treating the specific individual,” said Phyllis Hendry, MD, professor of emergency medicine for the UF College of Medicine – Jacksonville. “It’s big with cardiac patients, and the UF Health Personalized Medicine Program in Gainesville is doing genetic testing to determine which medicine will work best. I think that’s what will be happening with pain medicine in the future.”
Hendry is also the principal investigator of the Pain Assessment and Management Initiative, or PAMI, a free online education and patient safety project. In 2008, the PAMI team started working with Samuel McLean, MD, associate professor of emergency medicine and anesthesia at the University of North Carolina at Chapel Hill. McClean contacted Hendry to see if her team wanted to participate in Project CRASH, a study examining genotypic and phenotypic characteristics associated with the recovery process after a motor vehicle collision.
“Dr. McClean started out looking at why two people who are the same age, sex, race, socioeconomic class and who were in the same accident have different long-term reactions,” Hendry explained. The study focused on pain levels at six weeks, six months and one year after the event.
The goal was to see if there are genetic markers that may indicate why one person would have long-term depression, anxiety or chronic neck pain, but the other bounces back after the crash. Once a patient had been treated after an auto accident, they were evaluated to see if they were a good candidate for the study and willing to participate.
Patients who were asked to join had to meet strict criteria, but most notably, they had to be clinically stable and have no substantial soft tissue injuries, fractures or brain injuries. The study focused on three groups of people: European Americans ages 18 to 65, African Americans ages 18 to 65, and elderly patients over 65.
“We asked patients about their crash, the events surrounding it and what they recalled,” said Jennifer Bowman, research coordinator for UF COMJ. “Then we asked them about their pain related to the crash, what kind of pain they were in at the moment and past painful events.”
These questions provided the information being evaluated for the study, which concluded last year. McClean and his team, whose research is funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, are analyzing the DNA and survey results now.
Hendry explained that personalized medicine and genetic testing are important in pain management because each patient handles injuries and processes medications differently.
“Some people are rapid metabolizers, and if you’re a rapid metabolizer, certain pain medications are not going to work as well,” Hendry said. “The key is to realize some patients may not achieve adequate pain relief from certain medications because of insufficient drug metabolization, not because they are drug seekers. This is why a person’s genetic makeup is one of the important factors to consider.”
Historically, follow-up studies from the emergency room have a very low participation rate. However, the UF COMJ team won the award for Best Performance with Hard-to-Reach Participants in 2014 from UNC’s Project CRASH after having a 94 percent follow-up rate and being the second highest enroller of participants of this study.
The relationship with McClean and UNC will continue. “The new study we’re doing will be looking at other traumatic injuries,” Hendry explained. “UNC is coming here for a site visit in July, and the AURORA study will probably start in August.”
AURORA will focus on understanding and treating post-traumatic disorders in military veterans and civilian survivors.
“The AURORA study will be the most comprehensive trauma study ever performed, and involves the efforts of 19 institutions and 40 leading scientists,” according to UNC’s study explanation. “Led by scientists from the University of North Carolina and Harvard, this moonshot study will apply the latest tools in physiology, genomics and neuroimaging to achieve the quantum leap in knowledge that military veterans and civilian trauma survivors so desperately need.”
Featured Faculty
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Phyllis L. Hendry, MD, FAAP, FACEP
Professor
Associate Chair of Research