Observational Study of the Impact of Genetic Testing on Healthcare Decisions and Care in Interventional Pain Management

Specific genetic variations have been identified that result in alteration of expression or
function of receptors, enzymes, and transporters that are relevant to the safety and
efficacy of a medical treatment. By providing information regarding the genetic risks and
the most effective therapy for an individual patient, clinicians may improve the efficacy of
treatment and decrease the risk of adverse events.

The purpose of this study is to evaluate how currently available genetic tests are being
implemented in various interventional pain management clinics around the United States, and
whether this information results in benefits to patient care. Considering patient genotype
correlates with pain sensitivity and perception, as well as autonomic nervous system
dysfunction due to variations in sodium and potassium channels, genotypic associations can
significantly improve outcomes in interventional pain management modalities including:

- Injections (also called nerve blocks using medications), such as steroids and opioids,
including epidural steroid injections, facet joint injections, single nerve root
blocks, and sacroiliac joint injections;

- Radiofrequency Rhizotomy (radiofrequency ablation and neuroablation), using x-ray
guidance and a needle with an electrode at the tip that gets heated, to temporarily
turn off a nerve's ability to send pain messages to the brain; and,

- Intrathecal pump implants which provide potent medications straight to the source of
pain.

Patient that are receiving Proove Bioscience's genetic testing will complete validated
questionnaires to measure specific outcomes related to their treatment at each clinical
visit, including medication efficacy, reduction in adverse drug events, and healthcare
utilization. Physicians will document any changes made to treatment regimens, including
adjustments to medications or non-pharmacological treatments, and any improvements in the
outcome measures. Statistical analysis will be performed to calculate relationships between
genotypic and phenotypic data points collected in this study.

The results of this study will provide a measurable understanding of the medical and
economic value of implementing genetic testing into interventional pain management.
Furthermore, data points collected will be used to examine novel correlations and
associations between single nucleotide polymorphisms and longitudinal clinical outcome
measures.

Inclusion Criteria:

- Provide signed and dated informed consent form

- Willing to comply with all study procedures and be available for the duration of the
study

- Male or Female, at least 18 years of age

- Currently taking or a candidate for opioid pain medication

- Documented or recent complaint of pain within 90 days (location to be documented in
the case report form) with initial date of onset

Exclusion Criteria:

- Severe hepatic or renal disease (where current pharmaceutical dosing is affected
and/or requires adjustment of standard dosing prior to PGx testing)

- Significant diminished mental capacity that is unable to understand the protocol,
surveys and questionnaires; unable to read/write English or Spanish.

- Recent febrile illness that precludes or delays participation by more than 1 month

- Pregnancy or lactation

- Participation in a clinical study that may interfere with participation in this study

- Anything that would place the individual at increased risk or preclude the
individual's full compliance with or completion of the study