Urine drug testing has become an essential part of the management of patients with chronic pain. Testing provides objective information regarding drug compliance, diversion, and abuse to medications and to recreational drugs. Determining pharmacogenomics variants is also useful to determine individuals who are outliers from the expected urine drug concentrations, e.g., fast metabolizers having less drug and slow metabolizers having more drug present. Unfortunately, these tests are infrequently ordered. Knowledge of pharmacology and pharmacokinetics is important in interpreting laboratory results in order to provide physicians with the besting information to make optimal therapeutic decisions. Cases are presented to illustrate the variety of pain management medications that are available and how genetic variances affect the efficacy of the drugs and avoid toxicity. Patients on analgesic drugs for chronic pain have access to testing results and should learn what the results indicate. An educated patient is one that is more compliant with his/her medications.
1. Recite the important pain management medications in use today and the important routes of metabolism
2. Determine compliance to pain management test results based in prescriptions
3. Undertand how to interpret pharmacogenomics variances in the genes that encode cytochrome P450 with relevance to pain medications