A new clinical trial underway at the UC Gardner Neuroscience Institute is applying a personalized approach to pain management that doctors hope can improve post-surgical pain, reduce opioid dependence and reduce length of hospital stays.
More than half of patients who undergo spine surgery report poor pain control, and between 30 and 50 percent experience chronic pain for longer than 12 weeks (the time of routine tissue healing) following surgery.
“This is concerning because chronic post-surgical pain is associated with high monetary and non-monetary societal and personal costs caused by increased disability, opioid dependence, decreased quality of life and increased health care utilization,” said Owoicho Adogwa, MD, MPH, a physician-researcher affiliated with the UC Gardner Neuroscience Institute. “At the UC Health Back, Neck and Spine Center, we believe that an individualized and personalized approach that leverages our institutional expertise in pharmacogenomics, or researching how a person’s genes affect their response to medications, could transform how we manage post-operative pain.”
Pharmacogenomics is a field of research that studies how a person's genes affect how he or she responds to medications. Adogwa is leading a randomized control trial that will use patients’ genotypes to develop customized post-surgical pain regimens for spine surgery patients. Doctors believe that this personalized approach will result in better inpatient acute pain management – helping patients leave the hospital sooner, recover better at home and require less medication over time.
“For patients undergoing spinal surgery, we collect saliva and blood samples and analyze those samples prior to surgery,” Adogwa said. “This analysis provides information on exactly which class of pain medications they are most likely to respond to and benefit from. Essentially, we are using the patients’ biology to personalize the opioids used after surgery.”
By tailoring the medication regimen to the patient’s genotype, Adogwa hopes to administer lower dosages of pain medication in the hospital and less often than the current standard of care. In addition, blood tests will help determine the molecular genetic profile of patients most likely to recover rapidly after surgery.
Less pain medication can help post-surgical patients become active earlier, leave the hospital sooner and recover better at home with fewer complications. Better pain management in the inpatient setting can also help reduce the likelihood that patients become dependent upon opioids after they leave the hospital.
“Poor pain control in the weeks immediately following spine surgery is a major contributor to chronic opioid use. Therefore, optimal post-operative pain management in the inpatient setting could help reduce opioid addiction,” Adogwa said.
He said the study is the first of its kind in the field of adult neurosurgery, though similar genotype studies have been conducted in other fields of medicine. He hopes to enroll about 130 patients in the study over the course of two years.
More than a dozen patients have been enrolled since the study launched in May, and Adogwa said preliminary results are encouraging.
“With patients who have been randomized to the genotype arm, length of hospital stay is down and patients are leaving the hospital much faster. Patients in the genotype-guided arm of the study are leaving the hospital within 72 hours of surgery – surgeries that would have kept them here for five days compared to the traditional standard of care,” he said.
“This is personalized medicine at its best,” Adogwa said. “My hope is that 10 years from now, what we are doing in this randomized controlled trial will become the standard of care, independent of surgical approach or specialty.”