BlueCross BlueShield of Tennessee Medical Policy Manual

Pharmacogenetic Testing for Pain Management


Pharmacogenetic testing combines pharmacology and genomics with the intent of discovering effective and safe medications and doses tailored to a person’s genetic makeup. A number of commercially available panel tests (e.g., GeneSight® Analgesic, Proove® Opioid Risk Panel, Pain Medication DNA Insight™, Millennium PGT™, IDgenetix®) have been proposed as an aid in pain management.

Individual or panel tests relevant to pharmacogenetics could include testing of the following genes:




No high quality studies were found in the published literature that validates the use of pharmacogenetic testing for the treatment of pain. At present, the clinical utility of pharmacogenetic testing in pain management is poorly defined.


American Academy of Neurology. (2014). Opioids for chronic noncancer pain a position paper of the American Academy of Neurology. Retrieved January 22, 2019 from

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. Evidence Positioning System. (11: 2018). Pharmacogenic testing for pain management. (2.04.131). Retrieved January 18, 2019 from (7 articles and/or guidelines reviewed) Centers for Medicare & Medicaid Services. Palmetto GBA. (2018, October). CYP2C19, CYP2D6, CYP2C9, and VKORC1. (LCD ID L35072). Retrieved January 18, 2019 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). (Level 5 evidence)

Kapur, B. M., Lala, P. K., & Shaw, J. L. (2014). Pharmacogenetics of chronic pain management. Clinical Biochemistry, 47, 1169-1187. (Level 2 evidence)

Owusu, A., Hamadeh, I., & Smith, M. (2017). Review of Opioid Pharmacogenetics and Considerations for Pain management. Pharmacotherapy, 37 (9), 1105-1121. Abstract retrieved January 22, 2019 from PubMed database.

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. (Level 3 evidence)




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