Such interventions would have the potential to reduce the prevalence of chronic pain in the population .
Although certain risk factors can identify individuals who are most likely to develop chronic pain , few interventions to prevent chronic pain have been identified .
To facilitate the identification of preventive interventions , an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain .
We present general design considerations for prevention trials in population s that are at relatively high risk for developing chronic pain .
Genetic variability at COMT but not at OPRM1 and UGT2B7 loci modulates morphine analgesic response in acute postoperative pain
Purpose To investigate interindividual variability in response to pain treatment , we characterized postoperative patients for morphine metabolism and for COMT , OPRM1 and UGT2B7 polymorphisms . Methods A total of 109 patients treated with morphine  were genotyped by DNA sequencing for 12 DNA polymorphisms of the COMT , OPRM1 and UGT2B7 genes . The plasma concentration of morphine and of M3G/M6 G metabolites were evaluated by means of reversed phase high-performance liquid chromatography coupled with mass spectrometry . Results An association between average morphine consumption during the first 24 postoperative hours by patient-controlled analgesia ( PCA ) and COMT haplotypes was found . Specifically , patients with the diplotype for average pain intensity ( APS/APS ) required the lowest  morphine doses compared to the other subjects ( p = 0.011 ) . The APS haplotype contains an adenine corresponding to methionine , instead of valine , at position 158 of the COMT protein . Met/Met homozygous patients consumed significantly lower morphine doses than other subjects ( p = 0.014 ) ; accordingly , Val158Met genotyping alone might be used in the clinical setting to predict PCA morphine need . Considering both COMT Val158Met and OPRM1 A118 G polymorphisms , carriers of both the Met/Met and AA genotypes required less morphine than other subjects , although the difference was not significant . The analysis of UGT2B7 revealed the occurrence of two common haplotypes ( G_C_C_A_C and A_T_T_G_T ) that did not prove to be related with plasma morphine and M3G/M6 G concentration . Conclusions By considering COMT , OPRM1 , and UGT2B7 genotypes , as well as pharmacokinetic results , only COMT polymorphisms appear to be predictive of morphine need in postoperative pain therapy
Such interventions would have the potential to reduce the prevalence of chronic pain in the population .
Although certain risk factors can identify individuals who are most likely to develop chronic pain , few interventions to prevent chronic pain have been identified .
To facilitate the identification of preventive interventions , an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain .
We present general design considerations for prevention trials in population s that are at relatively high risk for developing chronic pain .