Encyclopedia of Molecular Pharmacology

Living Edition
| Editors: Stefan Offermanns, Walter Rosenthal


  • Christoph SteinEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-030-21573-6_6-1



Analgesics interfere with the generation and/or transmission of impulses following noxious stimulation (nociception) in the nervous system. This can occur at peripheral and/or central levels of the neuraxis. The therapeutic aim is to diminish the perception of pain.
  • Nonsteroidal Anti-inflammatory Drugs

  • Opioid Systems

Mechanisms of Action

Analgesics aim at modulating the generation of noxious chemicals (e.g., prostaglandins) or the activation of neuronal receptors/ion channels transducing/transmitting noxious stimuli (e.g., peptide receptors, Ca ++ channels). Clinically used drugs include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), antiepileptics, and antidepressants. Local anesthetics are used for local and regional anesthetic techniques. Mixed drugs (e.g., tramadol, tapentadol, serotonin/noradrenaline reuptake inhibitors) combine various mechanisms (Table 1). Acute and chronic pain are substantially different conditions. The treatment of...
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  1. Babu KM, Brent J, Juurlink DN (2019) Prevention of opioid overdose. N Engl J Med 380:2246–2255CrossRefGoogle Scholar
  2. Brune K, Patrignani P (2015) New insights into the use of currently available non-steroidal anti-inflammatory drugs. J Pain Res 8:105–118CrossRefGoogle Scholar
  3. Dowell D, Haegerich TM, Chou R (2016) CDC guideline for prescribing opioids for chronic pain – United States, 2016. JAMA 315:1624–1645CrossRefGoogle Scholar
  4. Fields HL, Margolis EB (2015) Understanding opioid reward. Trends Neurosci 38:217–225CrossRefGoogle Scholar
  5. Finnerup NB, Attal N, Haroutounian S, Mcnicol E, Baron R, Dworkin RH, Gilron I, Haanpaa M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162–173CrossRefGoogle Scholar
  6. Gonzalez-Hernandez A, Marichal-Cancino BA, Maassenvandenbrink A, Villalon CM (2018) Side effects associated with current and prospective antimigraine pharmacotherapies. Expert Opin Drug Metab Toxicol 14:25–41CrossRefGoogle Scholar
  7. Häuser W, Finnerup NB, Moore RA (2018) Systematic reviews with meta-analysis on cannabis-based medicines for chronic pain: a methodological and political minefield. Pain 159:1906–1907CrossRefGoogle Scholar
  8. Kaiser U, Treede RD, Sabatowski R (2017) Multimodal pain therapy in chronic noncancer pain-gold standard or need for further clarification? Pain 158:1853–1859CrossRefGoogle Scholar
  9. Negus SS, Freeman KB (2018) Abuse potential of biased mu opioid receptor agonists. Trends Pharmacol Sci 39:916–919CrossRefGoogle Scholar
  10. Reinecke H, Weber C, Lange K, Simon M, Stein C, Sorgatz H (2015) Analgesic efficacy of opioids in chronic pain: recent meta-analyses. Br J Pharmacol 172:324–333CrossRefGoogle Scholar
  11. Stein C (2016) Opioid receptors. Annu Rev Med 67:433–451CrossRefGoogle Scholar
  12. Stein C (2018) New concepts in opioid analgesia. Expert Opin Investig Drugs 27:765–775CrossRefGoogle Scholar
  13. Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Rice AS, Lunn MP, Hamunen K, Haanpaa M, Kalso EA (2013) Antiepileptic drugs for neuropathic pain and fibromyalgia – an overview of Cochrane reviews. Cochrane Database Syst Rev 11:CD010567Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg New York 2020

Authors and Affiliations

  1. 1.Experimentelle Anaesthesiologie, Charité Campus Benjamin FranklinFreie UniversitätBerlinGermany