Pharmacogenomic Guided Pain Management in Surgery: Patient PainOutcomes

Abstract

Background:
Postoperative pain remains common and variable across patients; pharmacogenomic guidance seeks to tailor analgesics to genotype to improve pain control and reduce opioid exposure.
Methods:
A systematic search of PubMed from inception to 28 Feb 2025 identified randomized and cohort studies in surgical populations where genotyping informed analgesic selection or dosing. The primary outcome was postoperative pain intensity within 24 to 72 hours on validated scales; secondary outcomes included opioid consumption converted to oral morphine equivalents, adverse events, and early recovery. Screening, extraction, and risk appraisal were performed in duplicate; findings were narratively synthesized.
Results:
Ten studies were included, four randomized trials and six cohorts. Pain effects were mixed. One arthroplasty trial reported lower mean pain over 10 days with genotype guidance, 3.1 vs 4.2 on a 0 to 10 scale, p<0.05, while a knee arthroplasty trial showed no difference at 24 hours, Overall Benefit of Analgesia Score 4.2 vs 4.7, p=0.55. A cohort within an enhanced recovery pathway showed better composite analgesia on postoperative day 1, 3.8 vs 5.4, and roughly 50% lower opioid use, p<0.01. Another randomized study observed lower two week opioid totals, median 200 vs 230 mg, p=0.047, with similar pain. In pediatric adeno- tonsillectomy, a COMT haplotype increased odds of opioid intervention, odds ratio 2.6, 95% confidence interval 1.2 to 5.4. Where reported, adverse effects were fewer with genotype guidance.
Conclusions:
Across surgical settings, genotype guided prescribing tended to reduce opioid consumption without worsening pain; effects on pain intensity were uncertain. Benefits appeared greatest when actionable phenotypes were targeted and recommendations were implemented reliably.