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Genetic Testing to see what medications are effective

Reformed1RReformed1 Posts: 257
edited 06/11/2012 - 8:43 AM in Pain Medications
I don't know how many people on this forum have had experience with genetic testing to see what medications they can tolerate. In a separate post, I had shared that my daughter is struggling with an excruciatingly painful neurological disease called RSD - Reflex Sympathetic Dystrophy. The pain she feels in her leg is the magnitude of having an amputation, over and over and over again. She has spent so many days and nights over the past three years crying, moaning, and even screaming in pain. It makes my back pain seem utterly trivial.

During the course of her 3-year journey now (and counting, because there is no cure for this disease), she has tried many treatment options. Interestingly, Physical Therapy is the golden treatment. It surpasses any medication available in terms of resolving her pain, and she has taken Morphine, Dilaudid, Tramadol, and Motrin. The latter two are the only things she takes today for break-through pain. She has also tried Amitriptyline, Lyrica, and Cymbalta, in an attempt to manage her neuropathic pain -- all of which caused horrific side effects for her.

I'm sorry for the poor intro because my post was intended to elaborate on a genetic test that is available to almost anyone who is struggling with medication. It is called "Cytochrome P450" or "CYP". Below is a link to a Mayo Clinic overview.


Please note that although the description mentions antidepressants, the test also provides very helpful information on a wide variety of pain medications as well. This is why I wanted to share the information on this forum. This test was tremendously helpful to our daughter's doctor, so I'm hoping it help some of you focus in on the medications that can really help you, and also save you a lot of time and agony by avoiding medicines that your body cannot metabolize.

I am not qualified to describe the test in detail. I would highly recommend that you talk to your doctor about this. I believe that even your PCP can order it, and I believe that it is covered by most insurance plans. Please check, because I believe that it can be rather expensive.

Best wishes to all!



  • I've never heard of this, but thanks for the information. It might help some members here and that's always a good thing.

    It's always great to hear about new technologies and testing procedures, so thank again for the post.

    I'm sorry to hear about your daughter - RSD is a nasty, nasty disease and I know it's very painful. It's wonderful to hear that PT has given her some much needed relief.

  • I should clarify that the CYP-450 test really provides a good indication of what medications are likely to be INEFFECTIVE based upon your genetic composition. It does not tell you what will be effective. This is explained in the Mayo Clinic link in my original post. Sorry for any confusion that I may have caused.

  • Wow, I had never heard of that- I can't imagine insurance pays for that for most of us usual suspects. Your poor baby, I can't imagine. What did it say about your daughter?

    I get as much relief from Tramadol as I do from a Vicodin, so I'm probably an insteresting case as well! But IV dilaudid was like the nectar of the gods when I had my accident. I would have kissed the anesthesiologist if I could have. If I could give that gene to your daughter and give her that level of relief every day, I sure as heck would.
  • Interesting article. It seems right now the test only checks a few drugs. What an amazing concept though.

    For someone like myself that is highly sensitive to MOST drugs that test would be a GODSEND. I've lost count how many drugs I've tried and had to discontinue. I shudder to think of the amount of money I've wasted on unused scripts over the years. Not to mention the endured side effects while seeing if they would eventually pass. I have tried several drugs that have actually begun to work on the pain but had to discontinue them due to the side effects. If I could just have some of that time back as well! I'm sure your daughter feels the same way! (Minus the pain of course.)

    It will be great to see that technology expanded to include more drugs and of course become a more acceptable medical practice for insurance companies.

    She sounds like she is having a horrible time and I only hope this testing helps them find something to ease her pain. None of the above mentioned drugs that your daughter tried worked for me either due to the side effects but I am able to tolerate Fentanyl in low dosage. Like HappyBMom, I would be more than willing to share that gene with her.

    I am curious how the test turned out for her.

    Best to you both.

  • Thank you for the loving thoughts and kind words. I honestly wasn't looking for sympathy for my daughter, but I'm very touched by your thoughtful comments and obvious empathy. Actually, she has become a model of strength for other children in chronic pain and even for some older people as well (like me!).

    I realize that the Mayo Clinic link doesn't provide much information about medications that are suitable for this type of test. I found a rather detailed list of the numerous medications that are candidates for the test at the link below:


    I found my daughter's printed test results as well. Interestingly, the ONLY analgesics she could tolerate well were Ibuprofen and Naproxen. She couldn't tolerate morphine or other opioids. Also, of the long list of antidepressants that could be candidates to treat neuropathic pain, she could only metabolize a few of them and thus we saved a lot of time by eliminating 90% of them as a result of this test.

    I hope the additional link is useful. You will see a much broader list of medications that could be analyzed by a test like this.

    Thanks again for your kindness! Best wishes in your search for effective pain relief!

  • As I mentioned, there is a genetic test called a Cytochrome P450 test that can help provide an indication of whether your body will be able to tolerate certain medications. Since my daughter had this test and it indicated a broad spectrum of medications that she could not tolerate, I thought that I had better do it as well.

    Sure enough, I had a similar pattern. I can't explain the test in detail because it is very complex, but at a high level, I had three different groups tested: 2D6, CY9, CY19.

    2D6 - includes most of the SSRI's as well as Cymbalta; my test result said that I am not likely to tolerate these very well

    2C9 - includes NSAIDS (e.g. Motrin) which I was able to metabolize extremely well, and that makes sense to me since Motrin had always been my best friend when in pain. I think it includes opioids as well.

    2C19 - includes several meds that I don't use. I recall Valium being in there. In my case, I am a very POOR METABOLIZER of these and should stay away from them.

    The test was done at my usual diagnostic lab (blood was drawn there) and they send it out to one of a few genetic testing centers. It was covered by my insurance since it presumably helped avoid a lot of wasted time and expense in trying various medications?

    If you would like to learn more, here is a link from one of my earlier posts:


    Best wishes,
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