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Anesthesiology/DNA polymorphisms and waking up screaming after every surgery

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Question
I have just gotten my DNA report back and I am loaded with snp's in the following:

CYP1A2
CYP1B1
CYP2D6
CYP2C9
CYP2C19
and
CYP34A

Each time I wake hysterical and screaming, nurses come running and start giving me injections to get the pain down.  It is very scary.  Is it possible I am being given the incorrect drugs based on my polymorphisms?  Additionally, I am a pain patient with an intrathecal pain pump with morphine inside and take oral morphine as well, until pump gets titrated up high enough.  I am having little to no effect from the morphine and I also wonder if these polymorphisms explain this too.

Thanks.

Answer
If you are a pain patient with morphine you have developed a tolerance to opioids and will require escalating dosages. Morphine is metabolized in the liver and therefore if your polymorphisms are the kind that cause rapid metabolism of morphine you will certainly see a reduced effect and duration of effect from morphine.

The only real choice is to choose higher doses of the opioid pain medications plus use adjuncts to help like Tylenol, toradol, and another drilling called ketamine in certain situations can be very helpful in opioid tolerant patients.

Anesthesiology

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Rex Russell

Expertise

Any question dealing with general anesthesia issues. With particular emphasis on regional anesthesia.

Experience

I am a board certified anesthesiologist, graduated from residency in 2004 from Johns Hopkins Hospital. I have since worked as an anesthesiologist first in the Air Force for three years and then most recently in Texas in Private Practice.

Organizations
Texas Medical Association Texas society of Anesthesiologists American Society of Anesthesiologists

Education/Credentials
BS, BYU MD, U of Texas, Galveston Intern-St. Joe's Hospital, Phx, AZ Internal Medicine Residency-Johns Hopkins Hospital, Baltimore, MD

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