How to prevent acute pain developing into chronic pain, How to treat pain without resorting to opioids How genetics, diet, and lifestyle all influence a person’s pain and whether it will become chronic.  How patterns of gene expression predict pain  How Big data can tell us about why people transition from acute to chronic pain

1. Precision Pain Medicine
New Era In Pain Therapy
Dr. Saeid Safari, MD., HMBA
Assistant Professor of Anesthesiology and Pain Medicine, FNRC, SBMU
Email: drsafari.s@gmail.com

2. Outline:
 Precision Medicine
 Personalized Vs Precision
 Towards Precision Medicine For Pain

4. Precision Medicine
 Precision medicine is a concept of offering the right
medication to a patient based on their genetic history.
 It is widely known that the one-size-fit-all approach never works
in medicine.
 Hence, doctors have to change the medication course from
time to time for a particular patient.

5. Precision & Personalized Approach
 Genetic and environmental factors related to a disease can
be judged.
 Based on which a proper medication regime can be formed
for different individuals.

6. The Right Drug For The Right Patient
 Disease processes differ from person to person; the effects of
drugs also vary.
 Individual differences between people – such as genes or age
– influence not only the onset of diseases, but also how drugs
are absorbed and metabolized in the body.

7. The Right Drug For The Right Patient
 Researchers hope that individually customized therapies will be
able to:
• Improve a patient's response rate to a chosen treatment,
• Reduce side effects,
• Shorten the treatment period – depending on the type of disease
involved.

17. Precision Pain Medicine
diagnostic biomarkers and repurposed drugs

18. Precision Pain Medicine:
The Emerging Approach To The Chronic
Pain Patient

19. Precision Pain Medicine
 Chronic pain is a major public health issue.
 Its management mandates a multidisciplinary clinical
assessment.
 Over the past decades, the individual variation in response to
analgesic medication has been shown to be tightly mediated
by the pharmacogenetic profile.

20. Precision Pain Medicine
 Better understanding of the molecular basis of pain
complemented by gradual unraveling of genotype–
phenotype associations hold important implications for clinical
utility and safety in the field of pain management.

21. Precision Pain Medicine
 However, as the pain community embraces the accumulation
of genomic data, it is worthwhile analyzing the caveats of a
pure gene-derived approach and consider the many
environmental factors that affect the highly complex
phenomenon of pain.

22. Pain Gets Personal
“Once Chronic Pain Develops, It’s Really Hard To Reverse,”
 How to prevent acute pain developing into chronic pain,
 How to treat pain without resorting to opioids
 How genetics, diet, and lifestyle all influence a person’s pain and
whether it will become chronic.
 How patterns of gene expression predict pain
 How Big data can tell us about why people transition from acute
to chronic pain

23. Journals in Pain And Precision
Medicine

24. Precision Pain Medicine Focuses On:
 Employing methods to assess each patient individually,
 Identify their risk profile for disproportionate pain and/or the
development of chronic pain
 Optimize therapeutic strategies to target specific pathological
processes underlying chronic pain.

25. Primary determinants of health
 There are two broad categories that contribute to chronic
pain risk:
1. Modifiable
2. Non-modifiable patient factors
1. Psychological,
2. Physiological,
3. Genetic Factors.

26.  Individual variation to drug response: the genetic component
 From the analgesic ladder to pharmacogenetics: a complex
translation
 Psychophysical correlations as a bridge to personalized
treatment

27. Genotype And Analgesic
Response In Patients With Pain

28. Conclusion & Future Perspective
 Genotype-driven patient assessment and its direct implication
on clinical practice represent a paradigm shift in the approach
to chronic pain.
 Determination of genetic traits would, in the future, be a pain-
specialist’s microsurgical means of directing therapeutic
strategies. Treatments would be selected based on the
probable mechanism leading to pain so that a patient’s
likelihood of gaining clinical benefit is enhanced.

29. Conclusion & Future Perspective
 However, it is worthwhile remembering that genetic code
determination is not sine qua non with a personalized
approach to pain. Subsets of individuals who are expected to
respond favorably to a given medication can also be
identified through nongenetic technologies.

30. Conclusion & Future Perspective
 Together with more nuanced pain-related recognition of
psychological, physiological and molecular processes,
personalized medicine should soon be the holy grail of the
management of chronic pain.
 Until we are there, the enigmatic puzzle of chronic pain should
continue to occupy our thoughts and stimulate our curiosity.