Phenoconversion and rural pain inequities: a precision-informed roadmap to advance equity for rural older adults.
- 1College of Nursing, University of Florida, Gainesville, FL, United States.
- 2Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, United States.
- 3Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, United States.
Abstract
Inequities in geriatric pain management persist despite three decades of research, disproportionately affecting older adults in rural communities. Structural barriers, multimorbidity, polypharmacy, and phenoconversion that alters functional drug metabolism, contribute to variable analgesic response and medication-related harm. The underrecognized mechanism, phenoconversion, is particularly consequential for patients prescribed CYP2D6-dependent analgesics, where drug-drug-gene interactions can render enzyme-dependent opioids ineffective or precipitate toxicity. Case-based illustrations demonstrate how unrecognized phenoconversion can lead to avoidable suffering and safety risks. Additionally, an implementation vignette highlights opportunities for integrating pharmacogenomics, shared decision making, and interoperable electronic care plans into rural primary care. These tools help ensure that critical information, such as patient goals, caregiver perspectives, and functional priorities, accompany medication decisions across transitions of care where phenoconversion risks may often be raised. Building on these insights, we propose a precision-informed roadmap calling for clinical decision infrastructure, telehealth-enabled specialty access, workforce development, and system-level support. When combined with person-centered care approaches, precision health care offers a promising pathway toward safer, more effective, and more equitable pain management for rural older adults.
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BibTeX
@article{hall2026phenoconversion,
title = {{Phenoconversion and rural pain inequities: a precision-informed roadmap to advance equity for rural older adults.}},
author = {Alexis K Hall and Emily J Cicali and Denise Schentrup and Andrew H Dubin},
journal = {Frontiers in pain research (Lausanne, Switzerland)},
year = {2026},
month = oct,
doi = {10.3389/fpain.2026.1883083},
url = {https://europepmc.org/article/MED/42952811},
note = {CC BY},
}
RIS
TY - JOUR
TI - Phenoconversion and rural pain inequities: a precision-informed roadmap to advance equity for rural older adults.
AU - Alexis K Hall
AU - Emily J Cicali
AU - Denise Schentrup
AU - Andrew H Dubin
PY - 2026
DA - 2026/10/14
JO - Frontiers in pain research (Lausanne, Switzerland)
DO - 10.3389/fpain.2026.1883083
UR - https://europepmc.org/article/MED/42952811
AB - Inequities in geriatric pain management persist despite three decades of research, disproportionately affecting older adults in rural communities. Structural barriers, multimorbidity, polypharmacy, and phenoconversion that alters functional drug metabolism, contribute to variable analgesic response and medication-related harm. The underrecognized mechanism, phenoconversion, is particularly consequential for patients prescribed CYP2D6-dependent analgesics, where drug-drug-gene interactions can render enzyme-dependent opioids ineffective or precipitate toxicity. Case-based illustrations demonstrate how unrecognized phenoconversion can lead to avoidable suffering and safety risks. Additionally, an implementation vignette highlights opportunities for integrating pharmacogenomics, shared decision making, and interoperable electronic care plans into rural primary care. These tools help ensure that critical information, such as patient goals, caregiver perspectives, and functional priorities, accompany medication decisions across transitions of care where phenoconversion risks may often be raised. Building on these insights, we propose a precision-informed roadmap calling for clinical decision infrastructure, telehealth-enabled specialty access, workforce development, and system-level support. When combined with person-centered care approaches, precision health care offers a promising pathway toward safer, more effective, and more equitable pain management for rural older adults.
SN - 2673-561X
ER -