BlueCross BlueShield of Tennessee Medical Policy Manual

Pharmacogenetic Testing for Pain Management


Pharmacogenetic testing combines pharmacology and genomics for the intent of developing effective and safe medications and doses tailored to a person’s genetic makeup.




No controlled studies were found in the published literature that validates the use of pharmacogenetic testing for the treatment of pain. No published studies were found reporting outcomes for patients managed with pharmacogenetic testing for pain management. Therefore, the clinical utility of such testing cannot be determined.


American College of Preventive Medicine. (2009) Genetic testing clinical reference for clinicians. Retrieved April 23, 2015 from http://www/

Bell, G. C., Donovan, K. A., & McLeod, H. L. (2015). Clinical implications of opioid pharmacogenomics in patients with cancer. Cancer Control, 22 (4), 426-432. (Level 4 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual. (11: 2015). Pharmacogenic testing for pain management. (2.04.131). Retrieved May 2, 2016 from BlueWeb. (53 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. LCD for pathology and laboratory: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing (L35660). Retrieved March 14, 2017 from

Crews, K. R., Gaedigk, A., Dunnenberger, H. M., Leeder, J. S., Klein, T. E., Caudle, K. E., et al. (2014) Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450 2D6 Genotype and Codeine Therapy: 2014 Update. Clinical Pharmacology & Therapeutics, 95 (4).

Jannetto, P. J., & Bratanow, N. C. (2009). Utilization of pharmacogenomics and therapeutic drug monitoring for opioid pain management. Pharmacogenomics, 10 (7), 1157-1167.

Kapur, B. M., Lala, P. K., & Shaw, J. L. (2014). Pharmacogenetics of chronic pain management. Clinical Biochemistry, 47 (2014), 1169-1187.

Scarpi, E., Calistri, D., Klepstad, P., Kaasa, S., Skorpen, F., Habberstad, R., et al. (2014). Clinical and genetic factors related to cancer-induced bone pain and bone pain relief. Oncologist, 19 (12), 1276-1283.

U. S. Food and Drug Administration. (2004, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. k042259. Retrieved April 24, 2015 from

Winifred S. Hayes, Inc. Genetic Testing Evaluation. (2014, November). Cytochrome P450 genotyping to predict response to opioid pain medications. Retrieved April 15, 2014 from (44 articles and/or guidelines reviewed)




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