Broader+Impact+-+Pharmacogenetics+and+Fibromyalgia

There is no cure for fibromyalgia. To date, the treatment of the disease has focused on control of symptoms (NIH).Therapies have focused on physical, psychological, and pharmaceutical factors:
 * Doctors have recommended aerobic exercise and practices such as Tai Chi and yoga.
 * They have also counseled cognitive behavioral therapy such as mindfulness practice.
 * And there have been the alternative medicine approaches: massage and chiropractic therapy and acupuncture.
 * Triggers for fibromyalgia have also been identified:
 * sleep apnea
 * anxiety
 * depression.
 * Drug therapy has focused on drugs that regulate serotonin and norepinephrine, for example, duloxetine (Cymbalta) and milnacipran (Savella), amitriptyline (Elavil) and cyclobenzaprine (Flexeril). Other drugs, such as pregabalin (Lyrica) and gabapentin (Neurontin), block nerve transmission (NIH).

In recent times, the **pharmacogenetic** approach to fibromyalgia has looked to the personal genome and the individual phenotypic expressions of pain receptors that result from variants. Genecards lists five drugs that address channels or pathways coded for by the TRPV1 gene (although not all of the mechanisms of actions are known):
 * capsaicin is a TRPV1 receptor antagonist;
 * alpha-linolenic acid is a full agonist;
 * aspartame and Icosapent work as inducers;
 * camphor works as an activator.

In 2016, the **//Proove Genetic Test for Fibromyalgia//** became available. Proove is not a diagnostic test for the disease. It is an indicator, rather, of how effective certain drug therapies can be given an individual’s genetic profile. Proove has identified ten genes that can impact the metabolism of drugs used to treat fibromyalgia, and one gene that is involved in symptoms such as sensitivity to pain and anxiety. A few sobering remarks about Proove are in order, however. For one thing, the test is expensive ($799). For another, this part of genetics is still an inexact science. Data indicates tendencies, not certainties. This is partly because so many other factors are involved in the expression of genes. Epigenetic determinants can turn genes on or off, and environmental factors can alter the effects of genes.

Why are such things as the Proove Genetic Test important? Because there is no such thing as “one size fits all” in drug therapy for fibromyalgia (or any other syndrome, for that matter). Each fibromyalgia sufferer will have a unique response to drug therapy based on his or her personal genome. Genes are responsible for the biological pathways that allow for the breakdown of drugs in the body. Genetic polymorphisms (SNPs) enhance, reduce, or inhibit the enzymes necessary for drug metabolism. It only takes one nucleotide polymorphism to impact metabolism. The benefit, then, of identifying polymorphisms is clear: doctors will be able to more quickly help patients find a therapy that will work for them.

Materials and Methods TRPV Genes Family Portrait Prevalence of Fibromyalgia Criticism of the Proove Genetic Test Discussion - The Genetic Approach to Fibromyalgia Works Cited