60 adults enrolled
Thirty participants were assigned to each arm. The PGx group had opioid prescribing informed by genotype. The comparison group received usual care.
THE PAIN CODE / JOURNAL CLUBفريق العمل
- محمد طلعت محمد محمد بلبص
- هدير ناصر عبدالحميد
- محمد احمد جمعه
- فرح شريف اسماعيل
- مريم احمد ابو قصيبه
- محمد السيد عبد الحكيم عالم
- محمد عبدالناصر صالح يعقوب
- ملك احمد ملوخية
- مارينا امجد انور صادق
- هاجر محمد اسماعيل
ALEXANDRIA NATIONAL UNIVERSITY
Can DNA change
how we treat pain?
One trial tested a three-gene approach to opioid prescribing. Make a prediction, explore the results, then see what the numbers leave open.
STUDY AT A GLANCE
One trial, two paths.
Researchers in Alicante, Spain, compared genotype-guided opioid prescribing with usual care for adults with chronic non-cancer pain. Here’s how to read the comparison.
Three genes studied
CYP2D6 is involved in drug metabolism, OPRM1 encodes the mu-opioid receptor, and COMT has been studied in relation to pain sensitivity.
50 completed follow-up
At month three, the analysis compared 28 PGx participants with 22 receiving usual care. That difference in retention matters when interpreting the results.
01 / MAKE THE CALL
Which group reported less pain?
Think about the patients who completed the three-month study. Pick the group you expect to have had the lower average pain score.
02 / THE DATA
Explore the three-month results.
MEAN PAIN INTENSITY · VAS 0–100 MM
A 21 mm gap among completers. The mean pain scores at baseline were 76 mm in the PGx arm and 71 mm in usual care.
03 / THE MECHANISM
From DNA
to drug response.
A 20-second visual explainer about the three genes studied. The animation uses on-screen text and plays on demand.
PGx / SHORT FILM20 SEC
One trial. Three genes.CYP2D6 · OPRM1 · COMT
Read the video transcript
The trial studied three genes. CYP2D6 helps convert tramadol to its active metabolite. OPRM1 encodes the mu-opioid receptor. COMT breaks down catecholamines and has been studied in pain sensitivity. CPIC provides CYP2D6 guidance for tramadol and codeine when genotype is known. It makes no opioid prescribing recommendations based on OPRM1 or COMT.
Metabolism. CYP2D6 helps activate tramadol. CPIC provides CYP2D6-based guidance for tramadol and codeine when genotype is known.
04 / THE TURNING POINT
But look at
the baseline.
At three months, median opioid dose was 35 mg/day in the PGx arm and 60 mg/day in usual care. Reveal where each group started.
MEDIAN MORPHINE EQUIVALENT DAILY DOSE · MG/DAY
35 PGx-guided60 Usual care
Show baseline
The PGx median barely moved. Usual care rose from an already higher starting dose, widening the gap.
05 / THE CRITICAL REVIEW
Look past the headline.
Open each card to see how the study design shapes what we can conclude.
01 Who was missing at month three?
Sixty adults were randomized. The analysis included 50 completers. Two of 30 in the PGx arm and eight of 30 in usual care were excluded during the trial. If those participants had different outcomes, the final comparison could be biased.
02 What drove the dose gap?
The PGx median changed from 34 to 35 mg/day. Usual care rose from 49 to 60 mg/day. The groups already differed at baseline, so the three-month gap needs that context.
03 How similar were the groups?
Among completers, 93% in the PGx group and 64% in usual care were women. In a small trial, differences like this can complicate interpretation, even with random assignment.
04 Would the findings transfer to Egypt?
This was a small, single-centre study in Spain. Local genotype data, testing access and cost-effectiveness matter before considering routine use in Egypt.
What applies in practice?
CPIC explains how known CYP2D6 results can inform codeine and tramadol prescribing. It gives no opioid dosing recommendations based on OPRM1 or COMT. The study evaluated a combined strategy, so its results cannot tell us how much any individual gene contributed.
CPIC guideline ↗JOURNAL CLUB TAKEAWAY
Promising early results. Larger multicentre trials with intention-to-treat analysis and cost-effectiveness data are needed before routine use of this three-gene approach.
06 / THE PEOPLE BEHIND THE POSTER
Meet the team.
PharmD Clinical Students · Faculty of Pharmacy · Alexandria National University
- محمد طلعت محمد محمد بلبص
- هدير ناصر عبدالحميد
- محمد احمد جمعه
- فرح شريف اسماعيل
- مريم احمد ابو قصيبه
- محمد السيد عبد الحكيم عالم
- محمد عبدالناصر صالح يعقوب
- ملك احمد ملوخية
- مارينا امجد انور صادق
- هاجر محمد اسماعيل