Several years ago, Eric Monesmith, MD, was approached by a friend who represented companies in the orthopedic industry about a new method that could improve pain management protocols for patients — genetic testing. The tests show providers how patients' genetics impact their ability to metabolize different categories of medications, notably narcotics. Dr. Monesmith has been utilizing genetic testing for total joint procedures at Indianapolis-based OrthoIndy for nearly two years and has seen success managing patients' postoperative pain.
"I can predict how my week is going to go based on genetic testing. I know who will be more challenging and who will fly through," Dr. Monesmith says. "Most people, including surgeons, often interpret pain complaints as merely complaining. In fact, nearly half the population is either a poor or intermediate metabolizer of typical narcotics, which limits their efficacy and increase side effects."
Genetic testing analyzes a patient's polymorphisms to determine whether the patient is a poor, intermediate, extensive or ultra-rapid metabolizer. If the testing reveals a patient is either an intermediate or poor metabolizer of narcotic medications, a surgeon can alter the patient's pain management program accordingly.
Dr. Monesmith notes patients who are poor metabolizers often are not receptive to some pain medications and therefore may experience negative side effects and require higher doses of medication. With the use of genetic testing, all facets of the surgical team are in sync with a patient's medications and why a patient is receiving a certain medication, ranging from the nursing staff to the anesthesiologist.
"With genetic test, surgery is a whole different ballgame," Dr. Monesmith adds. "Patients have fewer side effects. Our data is not 100 percent conclusive yet, but it is trending in a manner so that we have been able to reduce narcotic use and shorten the duration of narcotic use, while still keeping them comfortable."
For nearly 20 years before learning about genetic testing, Dr. Monesmith had assumed patients undergoing TJR that struggled with pain had a low pain tolerance.
"Using genetic testing has been a real eye-opener for me. A lot of people who complain of pain simply don't respond to the typical narcotic medications because of their genetics," he says. "Orthopedic surgeons are some of the brightest in the business and many don't know about genetic testing. I understand change is slow and everyone is busy, but surgeons should consider learning how this works and fit it into their practice."