Current medical research and opinion
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Pain is still one of the most prevalent and distressing symptom in patients with chronic pain. Opioids are the most potent existing analgesics available in clinical practice. However, they are not always effective, particularly in the non-cancer population. ⋯ Several different drug-development strategies have attempted to reduce side effects by exploiting anatomic barriers to drug distribution and to provide different analgesic mechanisms, as in the case of the oxycodone-naloxone combination or tapentadol. New delivery systems have been developed for a more effective management of breakthrough pain. Pharmacogenetics could play a critical role in personalizing pain management in the future.
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This commentary critically evaluates the limitations of genetic risk predictions in multifactorial disease, with specific reference to age-related macular degeneration (AMD). AMD is a common blinding disease with 33 million people worldwide experiencing vision impairment. ⋯ In the case of complex multifactorial disease such as AMD, to have the same predictive certainty that exists for monogenic disorders, we must account for all gene-environment interactions. We discuss sensitive vision tests that reflect causal gene-environment mechanisms and their potential in AMD risk prediction.