If pain medications don't work, there may be a reason.
Codeine and tramadol do not work as they arrive — your body has to convert them, using an enzyme called CYP2D6. Some people carry a version that converts poorly, which can mean little relief at a normal dose. Others convert unusually fast, which raises a safety question instead. Our 7-gene panel documents where you fall, from one cheek swab.
Pharmacogenetics
Pain Management PGx panel
7 genes, 14 medications (opioids, NSAIDs, anesthetics)
The cost of not testing
~1 in 12
Carry a CYP2D6 variant
People carry a CYP2D6 variant that changes how codeine and tramadol are processed.
40+
Medications covered
Pain, anesthesia and anti-inflammatory medications covered by the report.
Once
Test once
You only test once — share the same report with your prescriber before future surgeries and prescriptions.
Population figures come from published pharmacogenomic literature and are educational, not a prediction of your own result.
If your doctor, surgeon or pain specialist suggested this test, you are in the right place. Order below and we will get the report to your prescribing team before your next visit.
Everything you need to know, up front.
The total price, what is included, who orders your test, who reviews your results and when to expect them.
Total price
From $289
One-time price, shown in full at checkout before you pay. No separate fee for the kit, return shipping or the healthcare provider order.
What's included
Kit to report
A saliva or cheek-swab kit with instructions, a prepaid return label, the healthcare provider order, genetic testing in our lab and a gene-drug report in your secure portal.
Who orders the test
A licensed healthcare provider
A licensed healthcare provider in our network reviews your request and places the order during checkout, at no extra cost. No referral needed.
Who reviews the results
A board-certified geneticist
Every report is reviewed and signed in our lab by a board-certified molecular geneticist before it is released. Review your results with your prescriber.
When to expect results
A few business days
After the lab receives your sample. You are notified as soon as your report is in your secure portal.
Order a test
Choose the pain management PGx panel that fits your care. Kits ship to your door, or drop your sample off at our Maryland lab. No appointment and no insurance claim required.
From $289
All pharmacogenetics tests
NextCheckout opens in a new tab. Testing is not a diagnosis; results are reviewed with a licensed provider.
Is this test right for you?
If any of these sound familiar, this test was built for your situation.
Answering yes to even one of these is a good reason to test before your next prescription or procedure.
“It didn’t do anything” is a clinical finding.
People who do not respond to standard pain medication are too often assumed to be exaggerating or drug-seeking. Metabolizer status is one documented, testable explanation — and it belongs in your chart.
Little or no relief
Codeine and tramadol are prodrugs. If CYP2D6 converts them poorly, blood levels of the active form may stay low no matter the dose.
Too much effect, too fast
Ultrarapid conversion produces the active drug quickly, which is a recognized safety concern rather than a benefit.
NSAIDs that upset you
CYP2C9 affects how some non-opioid pain relievers are cleared, which is relevant if standard doses have caused problems.
7 genes across the medications pain care actually uses
One swab covers opioid and non-opioid analgesics together, because most pain plans use both — and because the non-opioid half is where a lot of avoidable trouble lives.
Opioid pathway
CYP2D6, CYP3A4, CYP2B6, OPRM1 — conversion and clearance for codeine, tramadol, oxycodone, hydrocodone and methadone, plus receptor-level variants.
Non-opioid analgesics
CYP2C9 and related NSAID genes — relevant to celecoxib, ibuprofen and other NSAIDs, the medications most people are told to try first.
Anesthesia & adjuncts
Perioperative and adjuvant medications — includes agents used around surgery and common adjuncts such as certain antidepressants used for nerve pain.
This is not a drug test. It does not detect medication in your system, monitor compliance, or influence whether anything is prescribed to you. It reports how your body is likely to process specific drugs, for your prescriber to interpret.
Documentation you can put in front of anyone.
Useful with your pain specialist, your surgeon's pre-op team, and any new provider who does not yet know your history.
Who this is for
The information matters most before a prescription is written — and before surgery, when there is still time to plan.
Chronic pain that is not controlled
Especially if more than one medication has been tried without much effect.
Surgery coming up
Pre-op is a natural moment to test: anesthesia and post-op analgesia are both on the panel.
A bad reaction in the past
Unusual sedation, nausea or non-response after a prior procedure is worth explaining rather than repeating.
Several prescriptions at once
Overlapping pathways are easier for a prescriber to plan around when your enzyme status is documented.
This is about safety and accuracy — not access to opioids.
We do not prescribe, and a test result does not entitle anyone to a medication. What it does is replace guesswork with documented metabolic information, so your prescriber can choose more confidently and revisit less often.
One swab. One time. Yours to keep.
No blood draw and no clinic visit — and never a repeat test, because your genome does not change.
Order online
Check out in about two minutes. A licensed healthcare provider in our network reviews and places the order at no extra cost.
Swab your cheek
Unmarked packaging, instructions inside. Collection takes under a minute with no fasting or prep.
Send it to our lab
Prepaid FedEx overnight label, or drop it at our Maryland lab in person, Mon–Fri 9am–5pm.
Bring it to your prescriber
Your report lands in a secure portal, ready to download or forward.
The science
What the evidence says about getting tested.
Codeine and tramadol are prodrugs: the body must convert them into their active form using CYP2D6. Poor metabolizers may get almost no relief from a normal dose; ultra-rapid metabolizers convert so quickly that the safety picture reverses. Non-opioid pain relievers follow the same logic through CYP2C9. CPIC guidelines and FDA labeling already assign specific caution categories to these gene-drug pairs — the science is mature enough to act on.
≈7%
of people are CYP2D6 poor metabolizers, who may get little relief from codeine or tramadol at normal doses.
Source: CPIC codeine guideline
1–5%
are CYP2D6 ultrarapid metabolizers, converting codeine unusually fast — a recognized safety concern after surgery.
Source: CPIC codeine guideline
50×
differences in codeine-to-morphine conversion between people have been documented — genetics, not dose, sets much of the spread.
Source: Clinical pharmacology literature
2–3×
higher celecoxib exposure in CYP2C9 poor metabolizers — the reason NSAID side effects cluster in this group.
Source: FDA celecoxib labeling
How often should you test?
Test once — your genotype doesn't change, and the information matters most before the next prescription is written or before surgery, when anesthesia and post-op analgesia can both be planned around your report.
References
- CPIC — Clinical Pharmacogenetics Implementation Consortium guideline for CYP2D6 genotype and codeine therapy.
- U.S. National Library of Medicine, DailyMed — codeine prescribing information: boxed warning for ultra-rapid metabolizers.
- U.S. National Library of Medicine, DailyMed — celecoxib prescribing information: CYP2C9 poor-metabolizer dose considerations.
- PubMed literature — CYP2D6 ultrarapid metabolism and morphine formation from codeine.
Population data
How common is each metabolizer type?
Published population frequencies for the cytochrome P450 enzymes read on this panel. Your report places you in one of these groups for each enzyme.
| Cytochrome | Poor metabolizer | Intermediate metabolizer | Normal metabolizer | Rapid or ultra-rapid metabolizer |
|---|---|---|---|---|
| CYP2D6 | 4–7% | 9–35% | 50–90% | 2–3% |
| CYP2C9 | 3% | 30% | 68% | N/A |
| CYP2C19 | 2–20% | 24–36% | 14–44% | 30% |
Population frequencies compiled from CPIC guidelines and FDA pharmacogenomic biomarker tables; frequencies vary by ancestry.
Questions people actually ask
Is this a drug test?
No. It does not detect medication in your body and it is not used for monitoring or compliance. It reads genes that affect how you metabolize certain drugs.
Will this get me a prescription?
No. The laboratory does not prescribe. The report gives your provider metabolic information; every prescribing decision stays with them.
I have surgery scheduled — when should I test?
As early as you can, so the report is in your chart before pre-op planning. Most reports are ready within a few business days of your swab reaching our Maryland lab.
Does my doctor need to order it?
No — a licensed healthcare provider in our network places the order during checkout. Do tell your own provider, since the report is only useful once they have it.
How much does it cost?
The Pain Management PGx panel starts at $289. You pay the laboratory directly, so no insurance claim is filed and no explanation of benefits is mailed.
Is my genetic data sold or shared?
No. Results live in a HIPAA-compliant portal only you can open, and we do not sell or license your genetic data. You choose who else receives a copy.
Do I need to repeat it later?
No. The same report stays valid for future prescriptions, new providers and future surgeries.
Know before the next prescription.
One cheek swab, one report — and a pain conversation that starts from evidence instead of assumption.
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