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Current and Emerging Pharmacologic Therapies for Pain and Challenges Which Still Lay Ahead

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Analgesia

Part of the book series: Methods in Molecular Biology ((MIMB,volume 617))

Abstract

This chapter seeks to provide a concise overview of the pharmacologic armamentarium available to treat pain. Drugs will be discussed in terms of their indications, mechanisms of action, and major side effects. For the purposes of this chapter, analgesics will be divided into two groups: current and emerging; current analgesics will be further subdivided into older analgesics and newer analgesics. Older analgesics will refer to drugs that have had FDA approval or were used off label for pain before 1990. Newer analgesics will refer to drugs developed or approved for treating pain since 1990. Finally, emerging analgesics will refer to drugs that have pre-clinical data or phase I/II data to suggest efficacy in treating pain but have not been validated by larger Phase III clinical trials. The chapter concludes with a chart that seeks to highlight current problems involved in pain pharmacotherapy.

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References

  1. Davis M (2005) Opioid Therapy. In: Pappagallo M (ed) The neurological basis of pain. McGraw-Hill, New York, pp 559–580

    Google Scholar 

  2. Pappagallo M, Werner M (2008) Chronic pain a primer for physicians. Remedica, Chicago, pp 154–98

    Google Scholar 

  3. Trescot AM, Sukdeb D, Lee M, Hans H (2008) Opioid pharmacology. Pain Physician 11(2 suppl):S133–153

    PubMed  Google Scholar 

  4. Bond C, LaForge KS, Tian M et al (1998) Single-nucleotide polymorphism in the human mu opioid receptor gene alters beta-endorphin binding and activity: possible implications for opiate addiction. Proc Natl Acad Sci U S A 95:9608–13

    Article  PubMed  CAS  Google Scholar 

  5. Dickenson AH, Kieffer B (2006) Opiates: basic mechanism. In: McMahon SB, Koltzenburg M (eds) Wall and Melzack’s textbook of pain. Churchill Livingstone, London, pp 427–442

    Chapter  Google Scholar 

  6. Golden BD, Abramson SB (2005) Nonsteroidal anti-inflammatory medications and acetaminophen. In: Pappagallo M (ed) The neurological basis of pain. McGraw-Hill, New York, pp 545–558

    Google Scholar 

  7. Chandrasekharan NV, Dai H, Roos KL et al (2002) COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression. Proc Natl Acad Sci U S A 99:13926–31

    Article  PubMed  CAS  Google Scholar 

  8. Cashman JN (1996) The mechanisms of action of NSAIDS in analgesia. Drugs 52:13–23

    Article  PubMed  CAS  Google Scholar 

  9. Kearney PM, Baigent C, Godwin J et al (2006) Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 332:1302–08

    Article  PubMed  CAS  Google Scholar 

  10. Graham GG, Scott KF (2005) Mechanism of action of paracetamol. AM J Ther 12:46–55

    Article  PubMed  Google Scholar 

  11. Bertolini A, Ferrari A, Ottani A et al (2006) Paracetamol: new vistas of an old drug. CNS Drug Rev 12:250–75

    Article  PubMed  CAS  Google Scholar 

  12. Bonnefont J, Daulhac L, Etienne M et al (2007) Acetaminophen recruits spinal p42/p44 MAPKs and GH/IGF-1 receptors to produce analgesia via the serotonergic system. Mol Pharmacol 71:407–15

    Article  PubMed  CAS  Google Scholar 

  13. Watkins PB, Kaplowitz N, Slattery JT et al (2006) Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial. JAMA 296:87–93

    Article  PubMed  CAS  Google Scholar 

  14. Tremont-Lukats IW, Megeff C, Backonja MM (2000) Anticonvulsants for neuropathic pain syndromes: mechanisms of action and place in therapy. Drugs 60:1029–52

    Article  PubMed  CAS  Google Scholar 

  15. Tegretol (Carbamazepine): Prescribing information. Novartis, Inc.

    Google Scholar 

  16. Schmutz McLean MJ, Wamil AW et al (1994) Oxcarbazepine: mechanisms of action. Epilepsia 35:S5–9

    Article  PubMed  Google Scholar 

  17. Schmidt D, Elger C (2004) What is the evidence that oxcarbazepine and carbamazepine are distinctly different antiepileptic drugs? Epilepsy & Behav 5:627–35

    Article  Google Scholar 

  18. Saarto T, Wiffen PJ (2007) Antidepressants for neuropathic pain. Cochrane Database Syst Rev 4: CD005454.

    Google Scholar 

  19. Gerner P, Haderer AE, Mujtaba M et al (2003) Assessment of differential blockade by amtriptyline and its N-methyl derivative in different species by different routes. Anesthesiology 98:1484–90

    Article  PubMed  CAS  Google Scholar 

  20. Backonja M, Glanzman RL (2003) Gabapentin dosing for neuropathic pain: evidence from randomized placebo-controlled clinical trials. Clin Ther 25:81–104

    Article  PubMed  CAS  Google Scholar 

  21. Sills GJ (2006) The mechanisms of action of gabapentin and pregabalin. Curr Opin Pharmacol 6:108–13

    Article  PubMed  CAS  Google Scholar 

  22. Maneuf YP, Luo ZD, Lee K (2006) α2δ and the mechanism of action of gabapentin in the treatment of pain. Semin Cell Dev Biol 17:565–70

    Article  PubMed  CAS  Google Scholar 

  23. Wallace MS (2006) Ziconotide: a new nonopioid intrathecal analgesic for the treatment of chronic pain. Expert Rev Neurother 6:1423–28

    Article  PubMed  CAS  Google Scholar 

  24. Knotkova H, Pappagallo M (2007) Adjuvant analgesics. Med Clin N Am 91:113–124

    Article  PubMed  CAS  Google Scholar 

  25. Turan A, Karamanlioglu B, Memis D et al (2004) Analgesic effects of gabapentin after spinal surgery. Anesthesiology 100:935–38

    Article  PubMed  CAS  Google Scholar 

  26. Eckhardt K, Ammon S, Hofmann U et al (2000) Gabapentin enhances the analgesic effect of morphine in healthy volunteers. Anesth Analg 91:185–89

    PubMed  CAS  Google Scholar 

  27. Rowbotham M, Harden N, Stacey B et al (1998) Gabapentin for the treatment of postherpetic neuralgia: a randomized control trial. JAMA 280:1837–42

    Article  PubMed  CAS  Google Scholar 

  28. Rice AS, Maton S (2001) Gabapentin in postherpetic neuralgia: a randomized, double blind, placebo controlled study. Pain 94:215–24

    Article  PubMed  CAS  Google Scholar 

  29. Bone M, Critchley P, Buggy DJ (2002) Gabapentin in postamputation phantom limb pain: a randomized, double blind, placebo-controlled, cross over study. Reg Anesth Pain Med 27:481–86

    PubMed  CAS  Google Scholar 

  30. Pandey CK, Bose N, Garg G et al (2002) Gabapentin for the treatment of pain in Guillain-Barré syndrome: a double blinded, placebo-controlled, crossover study. Anesth Analg 95:1719–23

    Article  PubMed  CAS  Google Scholar 

  31. Tai Q, Kirshblum S, Chen B et al (2002) Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double blind, crossover trial. J Spinal Cord Med 2005:100–5

    Google Scholar 

  32. Lesser H, Sharma U, Lamoreaux L et al (2004) Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology 63:2104–10

    Article  PubMed  CAS  Google Scholar 

  33. Crofford LJ, Rowbotham MC, Mease PJ et al (2005) Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double blind, placebo-controlled trial. Arthritis Rheum 52:1264–73

    Article  PubMed  CAS  Google Scholar 

  34. Dworkin RH, Corbin AE, Young JP Jr et al (2003) Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 60:1274–83

    Article  PubMed  CAS  Google Scholar 

  35. Owens MJ, Nemeroff CB (2003) Pharmacology of valproate. Psychopharmacol Bull 37(Suppl 2):17–24

    PubMed  Google Scholar 

  36. Depakote ER (Divalproex Sodium): Prescribing Information. Abbott Laboratories. Physician Desk Reference® PDR Network publisher, Mondale NJ, 2009

    Google Scholar 

  37. Jensen TS (2002) Anticovulsants in neuropathic pain: rationale and clinical evidence. Eur J Pain 6(Suppl A):61–8

    Article  PubMed  CAS  Google Scholar 

  38. Pappagallo M (2003) Newer antiepileptic drugs: possible uses in the treatment of neuropathic pain and migraine. Clin Ther 25:2506–38

    Article  PubMed  CAS  Google Scholar 

  39. Leppik IE (2004) Zonisamide: chemistry, mechanism of action, and pharmacokinetics. Seizure 13(Suppl 1):S5–9

    Article  PubMed  Google Scholar 

  40. Zakrzewska JM, Chaudry Z, Nurmikko TJ et al (1997) Lamotrigine (Lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain 73:223–30

    Article  PubMed  CAS  Google Scholar 

  41. Vinik AI, Tuchman M, Sairstein B et al (2007) Lamotrigine for treatment of pain associated with diabetic neuropathy: results of two randomized, double blind, placebo-controlled studies. Pain 128:169–179

    Article  PubMed  CAS  Google Scholar 

  42. Mattia C, Coluzzi F (2003) Antidepressants in chronic neuropathic pain. Mini Rev Med Chem 3:773–784

    Article  PubMed  CAS  Google Scholar 

  43. Coluzzi F, Mattia C (2005) Antidepressant, anticonvulsants, and miscellaneous agents. In: Pappagallo M (ed) The neurological basis of pain. McGraw-Hill, New York, pp 581–598

    Google Scholar 

  44. Rowbotham MC, Davies PS, Verkempinck C et al (1999) Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain 80:533–38

    Article  PubMed  Google Scholar 

  45. Mauskop A (2005) Migraine and cluster headaches. In: Pappagallo M (ed) The neurological basis of pain. McGraw-Hill, New York, pp 391–399

    Google Scholar 

  46. Nikai T, Basbaum AI, Ahn A (2008) Profound reduction of somatic and visceral pain in mice by intrathecal administration of the anti-migraine drug, sumatriptan. Pain 139:533–540

    Article  PubMed  CAS  Google Scholar 

  47. Wallace S (2006) Ziconotide: a new nonopioid intrathecal analgesic for the treatment of chronic pain. Expert Rev Neurothe 6:1423–28

    Article  CAS  Google Scholar 

  48. Prialt (Ziconotide) Prescribing Information. Elan Pharmaceuticals, Inc. Physician Desk Reference® PDR Network publisher, Mondale NJ, 2009

    Google Scholar 

  49. Pappagallo M (2005) Peripheral neuropathic pain. In: Pappagallo M (ed) The Neurological basis of pain. McGraw-Hill, New York, pp 321–337

    Google Scholar 

  50. Fukuda T, Furukawa H, Setsuji H, Hidenori T (2006) Systemic clonidine activates neurons of the dorsal horn, but not the locus ceruleus (A6) or the A7 area, after a formalin test: the importance of the dorsal horn in the antinociceptive effects of clonidine. J Anesth 20:279–283

    Article  PubMed  Google Scholar 

  51. Russell RG (2007) Bisphosphonates: mode of action and pharmacology. Pediatrics 119(Suppl 2):S150–62

    Article  PubMed  Google Scholar 

  52. Breuer B, Pappagallo M, Ongseng F (2008) An open-label pilot trial of ibandronate for complex regional pain syndrome. Clin J Pain 24:685–9

    Article  PubMed  Google Scholar 

  53. Varenna M, Zucchi F, Ghiringhelli D et al (2000) Intravenous clodronate in the treatment of reflex sympathetic dystrophy syndrome: a randomized, double blind, placebo-controlled study. J Rheumatol 27:1477–1483

    PubMed  CAS  Google Scholar 

  54. Cortet B, Flipo RM, Coquerelle P et al (1997) Treatment of severe, recalcitrant reflex sympathetic dystrophy: assessment of efficacy and safety of the second generation bisphosphonate pamidronate. Clin Rheumatol 16:51–56

    Article  PubMed  CAS  Google Scholar 

  55. Liu T, van Rooijen N, Tracey DJ (2000) Depletion of macrophages reduces axonal degeneration and hyperalgesia following nerve injury. Pain 86:25–32

    Article  PubMed  CAS  Google Scholar 

  56. Dong M, Pinon DI, Cox RF et al (2004) Importance of the amino terminus in secretin family G protein-coupled receptors. Intrinsic photoaffinity labeling establishes initial docking constraints for the calcitonin receptor. J Biol Chem 279:2894–903

    Article  PubMed  CAS  Google Scholar 

  57. Read SJ, Dray A (2008) Osteoarthritic pain: a review of current, theoretical and emerging therapeutics. Expert Opin Investig Drugs 17(5):619–640

    Article  PubMed  CAS  Google Scholar 

  58. Caterina MJ, Schumacher MA, Tominaga M et al (1997) The capsaicin receptor: a heat-activated ion channel in the pain pathway. Nature 389:816–24

    Article  PubMed  CAS  Google Scholar 

  59. Robbins WR, Staats PS, Levine J et al (1998) Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesth Analg 86:579–83

    PubMed  CAS  Google Scholar 

  60. Simpson DM, Brown S, Tobias J (2008) NGX-4010C107 Study Group. Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy. Neurology 70:2305–13

    Article  PubMed  CAS  Google Scholar 

  61. “Adlea™”. Anesiva. http://www.anesiva.com/wt/page/adlea. Accessed Oct 2008.

  62. Cabral GA, Marciano-Cabral F (2005) Cannabinoid receptors in microglia of the central nervous system: immune functional relevance. J Leukoc Biol 78:1192–97

    Article  PubMed  CAS  Google Scholar 

  63. Karst M, Salim K, Burstein S et al (2003) Analgesic effect of synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial. JAMA 290:1757–62

    Article  PubMed  CAS  Google Scholar 

  64. Richardson JD, Aaononsen L, Hargreaves KM (1998) Antihyperalgesic effects of spinal cannabinoids. Eur J Pharmacol 345:145–53

    Article  PubMed  CAS  Google Scholar 

  65. Bennett AD, Everhart AW, Hulsebosch CE (2000) Intrathecal administration of an NMDA or a non NMDA receptor antagonist reduces mechanical but not thermal allodynia in a rodent model of chronic central pain after spinal cord injury. Brain Res 859:72–82

    Article  PubMed  CAS  Google Scholar 

  66. Dickenson AH, Chapman V, Green GM (1997) The pharmacology of excitatory and inhibitory amino acid-mediated events in the transmission and modulation of pain in the spinal cord. Gen Pharmacol 28:633–8

    Article  PubMed  CAS  Google Scholar 

  67. Fitzgibbon EJ, Viola R (2005) Parenteral ketamine as an analgesic adjuvant for severe pain: development and retrospective audit of a protocol for a palliative care unit. J Palliat Med 8:49–57

    Article  PubMed  Google Scholar 

  68. Price DD, Mayer DJ, Mao J et al (2000) NMDA-receptor antagonists and opioid receptor interactions as related to analgesia and tolerance. J Pain Symptom Manage 19(Suppl 1):S7-S11

    Article  PubMed  CAS  Google Scholar 

  69. Marchand F, Perretti M, McMahon SB (2005) Role of the immune system in chronic pain. Nat Rev Neurosci 6:521–32

    Article  PubMed  CAS  Google Scholar 

  70. Sevcik MA, Ghilardi JR, Peter CM et al (2005) Anti-NGF therapy profoundly reduces bone cancer pain and the accompanying increase in markers of peripheral and central sensitization. Pain 115:128–41

    Article  PubMed  CAS  Google Scholar 

  71. Sommer C, Marziniak M, Myers RR (1998) The effect of thalidomide treatment on vascular pathology and hyperalgesia caused by constriction injury of rat nerve. Pain 74:83–91

    Article  PubMed  CAS  Google Scholar 

  72. Piao ZG, Cho IH, Park CK et al (2006) Activation of glia and microglial p38 MAPK in medullary dorsal horn contributes to tactile hypersensitivity following trigeminal sensory nerve injury. Pain 121:219–31

    Article  PubMed  CAS  Google Scholar 

  73. Ledeboer A, Liu T, Schumilla JA et al (2006) The glial modulatory drug AV411 attenuates mechanical allodynia in rat models of neuropathic pain. Neuron Glia Biol 2:279–91

    Article  PubMed  Google Scholar 

  74. Schiavo G, Matteoli M, Montecucco C (2000) Neurotoxins affecting neuroexocytosis. Physiol Rev 80:717–766

    PubMed  CAS  Google Scholar 

  75. Aoki KR (2005) Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology 26:785–93

    Article  PubMed  CAS  Google Scholar 

  76. Ranoux D, Attal N, Marain F (2008) Botulinum toxin type a induces direct analgesic effects in chronic neuropathic pain. Ann Neurol 64:274–83

    Article  PubMed  Google Scholar 

  77. Valeant Pharmaceuticals Starts Phase 2 Retigabine Study For Treatment Of Postherpetic Neuralgia. Medical News Today. 30 Nov. 2007. http://www.medicalnewstoday.com/articles/90315.php. Accessed 25 Oct 2008

  78. Wickenden A, Weifeng Y, Zou, A (2000) Retigabine, a novel anti-covulsant, enhances activation of KCNQ2/Q3 potassium channels. Mol Pharmacol 58:591-600.

    PubMed  CAS  Google Scholar 

  79. Wuttke T, Seebohm G, Bail S (2005) The new anticonvulsant Retigabine favors voltage-dependent opening of Kv7.2(KCNQ2) channel by binding to its activation gate. Mol Pharmacol 67:1009–17

    Article  PubMed  CAS  Google Scholar 

  80. Marrion NV (1997) Control of M-current. Annu Rev Physiol 59:483–504

    Article  PubMed  CAS  Google Scholar 

  81. Blackburn-Munro G, Jensen BS (2003) The anticonvulsant retigabine attenuates nociceptive behaviours in rat models of persistent and neuropathic pain. Eur J Pharmacol 460:109–16

    Article  PubMed  CAS  Google Scholar 

  82. Gao X, Kim HK, Chung JM et al (2007) Reactive oxygen species (ROS) are involved in enhancement of NMDA-receptor phosphorylation in animal models of pain. Pain 131:262–71

    Article  PubMed  CAS  Google Scholar 

  83. Zollinger PE, Tuinebreijer WE, Breederveld RS et al (2007) Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? J Bone Joint Surg Am 89:1424–31

    Article  PubMed  CAS  Google Scholar 

  84. Ziegler D (2008) Treatment of diabetic neuropathy and neuropathic pain: how far have we come? Diabetes Care 31(Suppl 2):S255–61

    PubMed  CAS  Google Scholar 

  85. Dworkin RH, O’Connor AB, Backonja M et al (2007) Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 132:237–51

    Article  PubMed  CAS  Google Scholar 

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Noto, C., Pappagallo, M. (2010). Current and Emerging Pharmacologic Therapies for Pain and Challenges Which Still Lay Ahead. In: Szallasi, A. (eds) Analgesia. Methods in Molecular Biology, vol 617. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-323-7_39

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  • DOI: https://doi.org/10.1007/978-1-60327-323-7_39

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