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1. Pain Med. 2012 Apr;13(4):604-9. doi: 10.1111/j.1526-4637.2012.01296.x.

CYP2D6 Poor Metabolizer Genotype and Smoking Predict Severe Postoperative Pain in
Female Patients on Arrival to the Recovery Room.

Yang Z, Yang Z, Arheart KL, Morris R, Zhang Y, Rodriguez Y, Song C, Gitlin MC,
Candiotti KA.

Department of Anesthesiology, Perioperative Medicine and Pain Management Division
of Biostatistics, Department of Epidemiology and Public Health Department of
Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida,
USA Department of Anesthesiology, The second clinical hospital of Harbin Medical
University, China.

Recent studies have shown that CYP2D6 acts at critical steps for endogenous
morphine biosynthesis. The present study assessed the contribution of CYP2D6
genetic polymorphisms, smoking, and other factors on acute severe postoperative
pain (linear analog pain scores ≥8). Methods.  Two hundred thirty-six female
patients were found to have adequate information in a previously developed female
surgical patient database to be included in this current analysis. Multiple
logistic regression analysis was used to assess the predictors for acute severe
postoperative pain. DNA had been previously extracted from blood samples in all
patients and was genotyped by the Amplichip to determine the specific CYP2D6
genotypes. Results.  It was noted that the incidence of acute severe
postoperative pain (linear analog pain scores ≥8) was more frequent in patients
with the CYP2D6 poor metabolizer (PM) genotype, 71%, compared with 28% in
intermediate metabolizers (IMs), 26% in extensive metabolizers (EMs), and 27% in
ultrarapid metabolizers (UMs). The overall association between metabolizer groups
and severe postoperative pain was significant (P = 0.023). PMs were significantly
more likely to suffer from severe postoperative pain than IMs, EMs, and UMs
(P = 0.007, 0.002, and 0.050, respectively). There were no significant
differences among IMs, EMs, and UMs. Additionally, it was noted that there was an
increased frequency of acute severe postoperative pain in smokers vs nonsmokers
(P = 0.014). Conclusion.  This study demonstrated that female patients possessing
the PM genotype of CYP2D6 and patients who smoke had a higher incidence of acute
severe postoperative pain.

Wiley Periodicals, Inc.

PMID: 22497725 [PubMed - in process]