For the estimated 50 million Americans who live every day with debilitating chronic pain, a full and active life may seem impossible. When pain treatment does not provide sufficient relief, a pain management clinic, with a customized therapy plan tailored to a patient's specific needs, circumstances, and preferences, can provide a great deal of comfort. Some specialize in particular diagnoses or in pain related to a specific area of the body, and most take a multidisciplinary approach to help people take an active role in handling their pain and regaining control of their life.1 These health care providers typically include doctors of a range of specialties as well as non-physician providers, such as psychologists, physical therapists, and complementary and alternative therapists like acupuncturists or massage therapists, focused in the diagnosis and management of chronic pain.
In many cases, patients are prescribed treatment before receiving other forms of therapy. Medications for pain may include non-aspirin pain relievers, nonsteroidal anti-inflammatory drugs, corticosteroids, opioid pain medications, and antidepressants. When medications alone are not adequate, other available treatments may include injections, nerve blocks, physical and aquatic therapy, whirlpool therapy, ultrasound, electrical stimulation, psychological support and counseling, relaxation techniques, and surgery -- often a treatment of last resort.2
Pain management clinics that must monitor patients' use and potential abuse of prescription drugs are now able to perform drug testing within their own facilities with the help of the Carolina Pain Laboratory. Carolina Liquid Chemistries offers a variety of UDT testing instruments, including the Biolis 24i, BS 200, CLC480, CLC720, and refurbished Olympus AU instrumentation.3 Both physicians and their patients can benefit by fast results on the patient's drug levels, and physicians can provide feedback to the patient regarding treatment decisions and medication adjustments on the same day as the office visit. In addition to faster results, an in-house laboratory analysis of prescription pain medication usage provides better quality control with lower risk of lab error or tampering. The Carolina Pain Laboratory package consists of instruments, reagents, and training, and includes assistance with validation, laboratory certification, and compliance. A dedicated Carolina Liquid Chemistries representative provides access to qualified laboratory CLIA/COLA consultants, billing and coding consultants, toxicologists, and clinical pathologists.3
A leading-edge study is offering renewed hope for patients living with chronic pain, and for the experts who treat them. Millennium Laboratories, a leading research-based clinical diagnostic company dedicated to improving the lives of people living with chronic pain, has initiated a landmark, sweeping prospective clinical outcomes study of its pharmacogenetic test.4 Millennium provides healthcare professionals with medication monitoring, drug detection, and pharmacogenetic testing services to personalize treatment plans to improve clinical outcomes and patient places a strong emphasis on industry research, education, and advocacy through its link with the Millennium Research Institute, a nonprofit national research center, dedicated to advancing the assessment and management of chronic pain.4
"Our company's commitment to furthering the science and field of pain management includes providing research that supports best practices," said Howard Appel, President of Millennium Laboratories, in a press release. "To that end, this study will seek to expand and improve an understanding of how genetic variability affects response to prescribed medications to help improve medication choices and efficacy, and minimize side effects -- potentially resulting in improved patient care."
The ground-breaking longitudinal study will evaluate the relationship of genetic variability and clinical pain management outcomes and cover more than 30 U.S. trial sites. Up to 1,250 subjects meeting the study entry criteria will be registered into the opening, cross-sectional phase.4 Subjects classified by the test as poor or ultra-rapid metabolizers will continue into the next, longitudinal phase of the study. The study will gauge the association between a patient's CYP genotype and key clinical effects, including level of analgesia, functional status, and clinically significant opioid-related adverse events, which may help physicians manage a patient's pain more effectively and safely. "Ongoing research," says Michael Brennan, M.D., a nationally recognized pain specialist practicing in Fairfield, Connecticut, "will be critical in helping to facilitate a better understanding of the important role this new tool can play in pain management."
Following the launch of Millennium's pharmacogenetic test to healthcare professionals, the study will also seek to assess the benefit to prescribers of pharmacogenetic information arising from Millennium PGT, and characterize any corresponding changes in prescribing patterns. The PGT saliva-based testing identifies genetic distinctions in enzymes associated with the metabolism of medications often prescribed to patients suffering from chronic pain. Designed to serve as a tool to support personalized therapy, the test will help clinicians isolate patients who may benefit from adjusting the drug selection or dosing of certain prescribed opioids including methadone, benzodiazepines, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs).4
Millennium also provides education and support for using pharmacogenetics, a new territory in pain management, in clinical practice. Pharmacogenetic testing supports the discovery of genetic variations in enzymes associated with the metabolism of medications frequently prescribed to patients suffering from debilitating chronic pain.4
Laura Kovacs is a freelance writer based in Philadelphia.
- Ephraim K Brenman, DO (March 2007). Pain Management: Diagnosing the Cause of Pain. Webmd. Retrieved December 10, 2012 from www.webmd.com/pain-management/guide/pain-clinics-overview?page=2.
- Dennis Turk, et al (2009). Interdisciplinary Pain Management. American Chronic Pain Association. Retrieved December 10, 2012 from www.theacpa.org/26/PainManagementPrograms.aspx.
- Carolina Liquid Chemistries Corp. (2012). Pain Practice Laboratory. Carolina Liquid Chemistries Corp. Retrieved December 10, 2012 from http://www.carolinachemistries.com/CLC/index.cfm/hurl/idsPageID=133/Type=/Carolina-Liquid-Chemistries-Home.
- Millennium Laboratories (August 21, 2012). Millennium Announces Landmark Pharmacogenetics Clinical Outcomes Study. Millennium Laboratories. Retrieved December 10, 2012 from http://millenniumlabs.com/2012/08/22/millennium-announces-landmark-pharmacogenetics-clinical-outcomes-study/