CYP2D6 Testing and Postoperative Opioids

Investigators evaluate whether genotype-guided prescribing improves postoperative pain management.

By
Kathryn Wighton
March 9, 2026
5 min

MDSpire News

Objective:

To evaluate the impact of CYP2D6-guided opioid prescribing on postoperative pain and opioid use compared to usual care.

Key Findings:

Genotype-guided prescribing increased concordance between opioid selection and metabolic phenotype (64% vs 27%).
Hydrocodone prescribing decreased in the genotype-guided group (24% vs 58%), while hydromorphone use increased (39% vs 3%).
Postoperative pain outcomes were similar between groups, with mean Silverman scores of 1.4 and -1.4 respectively, and nonopioid strategies were frequently used.

Interpretation:

CYP2D6-guided opioid prescribing altered prescribing patterns but did not improve postoperative pain control or reduce opioid use, raising questions about its clinical utility.

Limitations:

Prescribers' autonomy may have led to incomplete adherence to genotype-based recommendations, and high variability in the Silverman score may have obscured differences between groups, with missing data affecting about 11% of the actionable population.

Conclusion:

The study concluded that CYP2D6-guided opioid therapy does not enhance pain management in the context of multimodal postoperative care, highlighting the need for further research.