Does Pharmacogenomic Testing Improve Drug Tolerance and Pain Relief in Male Patients, Aged 20-50 with Chronic Lower Back Pain
Alessandra R. Chatson-Peaslee, MSN, FNP-C
Maryville University
Dr. Grahm
November 4, 2015

Outline
Problem Statement
Lower back pain in becoming a common problem across age groups with a notable increased in prevalence, and morbidity and mortality rates (NIH, 2015). The approaches to addressing lower back pain mostly fail to consider the genetic variation, which can affect the effectiveness of the drug choice. Introducing pharmacogenomics testing in decision making regarding the right medication, individualizes care; thus, a possibility of promoting drug tolerance and pain relief.
Importance of the Topic
The prevalence lower back pain has increased to become among the top three causes of morbidity in the USA, with 80% of adults reporting lower back pain complaints in their lifetime (Freburger, Holmes, Agans et al., 2009; and NIH, 2015. Although there is a high prevalence with an increase in age (Hoy, Bain, Williams et al., 2012), the condition is not age specific. Main caused of chronic lower back pain are mechanical factors affecting the structure of the vertebrae at the vertebra disc, ligaments, tendons, articulation points, or the surrounding muscles (NIH, 2015). The implications of chronic pain range from increased health problems, disabilities, absenteeism from work, and hospital workload. Hoy, Bain, Williams et al., 2012, estimate the cost to be in the ranges of US dollars 100-200.
PICO Question
The PICO question for this study in males aged 20-50 years with chronic lower back pain does pharmacodynamics testing improve drug tolerance and pain relief as compared to the commonly used approach of trial and error.

Search History
The articles to be used in this study will be retrieved from Google Scholar, PubMed, and MEDLINE databases. The databases will be fed with keywords that include pharmacogenomics testing, lower back pain, drug tolerance, pain management. The resulting articles will be selected on the basis of full articles, recentcy (less than ten years), relevance, evidence level, validity, reliability, and credibility of the article to be achieved through articles appraisal.
Literature Review
a. Aspects of Pharmacogenomics Testing
Evaluate levels where genomics may play a role in drug availability. These aspects include drug absorption, drug distribution, drug metabolism, receptors, and drug excretion. These aspects may vary based on the drug category (NSAIDs, Opioids, Steroids, and Narcotic) (Haga & LaPointe, 2013).
b. Benefits of Pharmacogenomics Testing
The probable and actual benefits of pharmacogenomics testing will be evaluated at this level. They may include reducing drug to drug interactions, reducing patient-drug interactions, cost-effective care, increase drug tolerance, avoid inappropriate medication, and promote individualized care (Sim & Ingelman-Sundberg, 2011).
c. Challenges of Implementing Pharmacogenomics Testing
The challenges to be investigated include the issue of consent from the client, ability to respond urgently, the cost of conducting pharmacogenomics testing, the perception from clients, resources availability, and expertise availability (Haga & LaPointe, 2013).
Theoretical Framework
The theory to be used in this will be the client-centered therapy theory, which emphasizes on offering individualized care rather than generalized care. Pharmacogenomics testing seeks to improve drug therapy based on the client genetic factors. The different client will respond to differently based on drugs due to genetic characteristics, which affect drug absorption, distribution, metabolism, availability, and excretion. These differences can be linked to ethnicity, race, and locality. Therefore, evaluating the specific factors for the male patients with chronic lower back pain with the aim of improving drug tolerance and pain relief is very much in-line with the client-centered therapy model (Haga & LaPointe, 2013).

References
Freburger, J., Holmes, G., Agans, R. et al. (2009). The rising prevalence of chronic low back pain. Archives of Internal Medicine. 169(3):251-258.
Haga, S.B. & LaPointe, N.M. (2013). The potential impact of pharmacogenetic testing on medication adherence. The Pharmacogenomics Journal. 13(6):481-483.
Hoy, D., Bain, C., Williams, G. et al. (2012). A systematic review of global prevalence of low back pain. Arthritis & Rheumatism 64(6):2028-2037
NIH (2015). Back pain: fact sheet. National Institute of Neurological Disorders and stroke. Retrieved October 30, 2015 <http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm>
Sim, S.C. & Ingelman-Sundberg, M. (2011). Pharmacogenomic biomerkers: new tools in current and future drug therapy. Trends in Pharmacological Science. 32(2): 72-81.

 
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