Decoding the role of epigenetics and genomics in pain management.

Persistent pain is a costly epidemic, affecting >50 million Americans with estimated expenditures of >$200 billion annually for direct care and lost productivity. Recent advances in epigenetic/genomic understanding of pain and analgesic response may lead to improvements in pain management and help curtail costs by providing more precise detection of the pain mechanisms involved and thereby more personalized and effective treatments. However, the translation of epigenetic and genomic strategies for pain management into clinical practice will depend on understanding their potential applications. The purpose of this article is to examine current knowledge about epigenetic and genomic mechanisms of persistent pain and potential opportunities for improving pain management. The initial discussion focuses on present understanding of nociceptive pathways and alterations that lead to pathologic pain. The discussion then moves to a review of epigenetic mechanisms that have been identified in the transition to and maintenance of persistent pain as well as in the individual's response to analgesics. Potential applications of epigenetics/genomics to identify people at risk and possibly prevent persistent pain and guide diagnosis and the selection of therapeutic modalities are presented. Published by Elsevier Inc.