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tortoisegirl 07-28-2013 03:54 PM

Re: DNA test for pain meds

My pain doctor asked if I wanted to take the test. It seems that this isn't too widespread yet. I don't see why any doctor would make a patient take it (as they would a urine test as part of their contract). It just gives the doctor and patient additional info that could be helpful in choosing medications.

I would be surprised if any doctor besides a pain specialist would offer it, although I imagine a well-informed patient could request their doctor order the kit, perform the swab test, and send it out. As far as I know, insurance typically covers it. I'll have to report back what my explanation of benefits says on the cost.

In case anyone was curious, mine involved swabbing my mouth with a q-tip with a longer stick (buccal swab), twice on each side (four swabs total). They then put the swabs in a ziploc and mailed it out with some paperwork to the company (PGxl laboratories). Mine was called a "generic drug sensitivity test". The handout I got said they send the results to the doctor 3-5 business days after receiving your sample.

Here is a paraphrasing from some info from the handout I got:

Genes control how the body reacts to certain drugs. This test can make sure certain drugs will be safe and effective for a patient. They test cytochrome P450, which is a gene complex which controls liver enzymes that digest certain drugs. In addition to pain meds, this same test could be used to evaluate beta blockers and antidepressants among other meds. (I assume they select certain medications or medication classes on the paperwork)

The test will show how quickly your body filters a given drug out of the bloodstream. A high metabolizer may flush the drug out of the body quickly, and never receive benefit from the normal dose. A poor metabolizer may have that normal dose build up on the system to a potentially dangerous level.


Interesting you also take methadone four times a day; that seems pretty rare. Agreed that it is annoying it only comes in 10mg pills. My doctor will only do a max of 200 pills per script, so I have to fill it every 2 weeks. At least he gives me both scripts at my monthly appointment though. I've had the same response with everything I've tried for breakthrough (which is basically everything). Its similar to my response to the long acting meds.

I imagine this test wouldn't explain my response if its just tolerance though, which I think it is (otherwise I would get some relief but it might just be very short lived?). I know its possible to have much higher tolerance to some meds than others, which is why they should give you a lower dose than they expect you'd need when switching pain meds. I've only been using a couple doses a week lately and it still doesn't work so great, but its better than nothing. Best wishes.

SK59 07-28-2013 07:29 PM

Re: DNA test for pain meds
[QUOTE=LadyVols;5204274]About your reluctance to take prescription pain meds - I've walked in your shoes. After many years of high doses of over the counter meds, my internist asked me if I wanted to end up on dialysis, because that will happen if I didn't cut it out. She encouraged me to take opioid meds and said that unless I misuse them, they are much better for my body than the over the counter stuff. Please don't be scared to make the change. You don't have to start on heavy duty ones. Lortab has helped me for four years and only the past six months or so has it seemed to finally become not so effective.

Don't wait until you've damaged your kidneys, which I did a little bit.[/QUOTE]

I got a call from the PM doc that my PCP has been consulting with and he eased my mind about taking the oxycodone. He asked me to start alternating the ibuprofen with the oxy every 6 hours and hopefully I will see how much relief I get that I will be willing be make a total switch.

I get plasmaphersis every 3 weeks and the nursing team that does it for me also does dialysis for other patients. It makes them crazy when they hear how much ibuprofen I take. However, my liver function and kidney function gets checked every 3 weeks prior to the pheresis and so far they are pretty good, so I guess I have been lulled into a false sense of security.
I do know that I should not be taking as much as I do, but psychologically it makes me feel better to be taking over OTC meds rather than narcotic pain meds.

When I am hospitalized I do take fairly large doses of pain medicine and I am ok with that, I just have issues with taking them at home. Crazy, I know!

Please let me know about your DNA results. I am fascinated!


Lotty667 07-28-2013 07:34 PM

Re: DNA test for pain meds
4 times a day just worked better for me. I think that is why I don't need the breakthrough is often. I actually take them every 6 hrs. I don't really sleep more than a few hours at a time, so it works for me. Although it is kind of funny that the only time I seem to need the breakthrough is at night. Hmmm??

One of the things that makes the 10mg tablets so annoying is that I know that there is a 40mg tablet out there. For whatever reason, it is only used for the addiction area of treatment. Can you imagine going from 16 tablets a day to only 4??!!

It's great to meet someone who is on basically the same regime as I am. Please let me know when you get the results of the DNA test. I am very interested. Take Care.

noevr 07-28-2013 07:54 PM

Re: DNA test for pain meds
Sarah I just wanted to add that I believe the issue is the overall longterm effect of using ibuprofen. I have a friend who now has to have her kidney function checked often and can't take any nsaid. She is just 58. She has had two hip replacements since and hasn't been able to take any. Just a thought. Cathy

SK59 07-28-2013 08:06 PM

Re: DNA test for pain meds
I have been taking 800 mg. every 4-6 hours for years. I take 800 every morning when i wake up and 800 every night when I go to bed and then all day throughout the day. This is what my PCP is so upset about-especially because I have a lot of stomach issues.
I know I shouldn't be doing this and it has gotten to the point where every doctor & nurse I encounter is after me to stop taking them.

I am 54 and my doctors say it is imperative that I stop this now.

It has taken me awhile to wrap my head around this but I think they have finely gotten my attention!

Old habits are hard to stop.....!


noevr 07-28-2013 08:20 PM

Re: DNA test for pain meds
Sarah do you have kids? Reason I'm asking my friends mom needs kidney replacement she's about 60 hers is from high bp over the yrs. Anyway my friend was going to donate one of her kidneys but she's not compatible she's very upset.

Just something else to think about. Not trying to scare you but the daughter really wanted to help. Cathy

SK59 07-29-2013 05:26 AM

Re: DNA test for pain meds
I do, 2 grown daughters.
They have been though so much that all my medical stuff is just routine. I used to be in the hospital for 4-5 weeks at a time when they were young, but when I was out of the hospital I was really good at putting on a good face so we didn't make it a day to day focus.

I know I need to stop, but I think because we keep such a close eye on my liver & kidney function & it seems to be within range, I keep thinking that I am okay.

I go to my doctor once a week, so he has been on me about it pretty consistently :/


blondielou 07-29-2013 10:49 AM

Re: DNA test for pain meds
I've had one and there is nothing to it. All they do is get a cheek swab. What the DNA test will do is check how your metabolism is processed, it will either be normal or abnormal. Mine actually turned out to be abnormal, I was the second person in the entire practice that had that result. Then the test will give a list of recommended medication that works more effectively. So what does this mean?

What happens with almost all medications is that over time your body builds up a tolerance because it's use to it. It's the new daily routine and not something newly introduced to your system. Right now you're on a Schedule III medication, I'm currently on a Schedule II medication. I told my doctor the same thing, that I didn't feel it was working so he did the DNA test. Before a doctor changes your medication they're going to see if your body is normal or abnormal. Your doctor has to weight the risks because if you get something stronger and hit a wall again, you're on the path to methadone, where you have take your pill in front of a nurse out of a paper cup. Class I contains substances such as heroine, Ecstasy and marijuana), so if you hit a wall in Class II...... meth is even considered a Class II (Dilaudid, Percocet, morphine). So many people just say "Oh it's not working" because they want something stronger. The DNA test tells the truth, my was abnormal so the suggestion that was listed was Opana but that was a once a day so I decided to stick with my Nucynta instead. But if I ever start getting better when I start to taper off I'm going to switch to the once a day

noevr 07-29-2013 11:04 AM

Re: DNA test for pain meds
I take opana er 30 mg 2 times a day and 10 mg of opana ir 3 times a day for breakthru works great. Cathy

Lotty667 07-29-2013 02:05 PM

Re: DNA test for pain meds
Hi Blondie. Just wanted to note that I take methadone on a daily basis for pain management and have never, ever had to take it front of a nurse. That is for the addiction area in which methadone can also be used.

Taking methadone doesn't mean that you've hit a wall with all other medications, it just happens to be one that works very well for some people, myself being one of them. It is also cheap, so if for some reason, I didn't have insurance to pay for it, I would still be able to afford it.

Just a clarification in case someone out there is thinking of using methadone for pain management. For pain management, it is prescribed just like any other narcotic med.

galalena 07-29-2013 06:09 PM

Re: DNA test for pain meds
I take methadone as well, a very low dose and I am doing my best to keep it that way. Although that is very hard, but still hoping I will recover more from the most recent surgery. Of course it IS a pain med like any other and I, like everyone else, do not have to take it out of a paper cup! I have never even had a urine test or pill count with this pain doc, who is very conservative.

tortoisegirl 07-29-2013 08:58 PM

Re: DNA test for pain meds
I agree with Lotty's clarification. Methadone for pain management is always a prescription from a pharmacy, same as any other pain med, and can be used for any level of tolerance in folks with chronic pain (although its typically not a first line med).

Although I have heard of some folks for example being kicked out of pain management so then they would go to a methadone clinic (when they were in withdrawal as they had been cut off from their medication) to receive methadone once a day (which isn't so effective for pain, as it is best dosed 2-4 times a day for that). It may also be a good idea not to abbreviate methadone as "meth", as that typically refers to methamphetamine!

Also, this type of DNA test will not show a patient's tolerance to a will only show how well (or not) you metabolize it. They are two different things. There is no test for tolerance as far as I know besides taking the med and seeing how it works for you.

Tolerance would be the med not working well at that dose (you would need a higher dose, or they would try a different med) while being a fast metabolizer of the med would typically mean you would need the medication dosed much more frequently (or it may not even have any effect on you). This test can also show if you are a slow metabolizer (and they should start you on a lower dose/schedule or skip that med). Best wishes.

LadyVols 07-30-2013 08:24 PM

Re: DNA test for pain meds
[QUOTE=behindthemakeup;5204340]I did not know about the test but I will ask about it at my next pain management appointment. Lady Vol depending on where you are in our great state would matter, but I do have an excellent pain management doctor, and he does LISTEN. To me that is the most important thing.[/QUOTE]

Thank you for your reply and I'm glad you have a good doctor. I'll let you know on my future DNA test. I'm near Knoxville. I know there are some good pain doctors here, it's just so hard to start all over.

LadyVols 07-30-2013 08:27 PM

Re: DNA test for pain meds
BB07, thank you! I also have Humana. I may look in to that. (re pain pump)

LadyVols 07-30-2013 08:55 PM

Re: DNA test for pain meds
Kate, are you going to have to wait until your next visit to get your results?

I'm so scared to take the test in the morning. I'm scared he'll change me to something I don't want to take, even if it's just psychological, like methadone is to me due to my brother. Plus I have a terrible family history of fatal heart attacks in 40s and early 50s so the EKG requirement scares me, too.
