The Pharmaceutical Journal
Vol 279 No 7471 p354-356
29 September 2007

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Chronic pain management: advances

Andrew Dickman describes selected aspects of the neurophysiology of pain and discusses several products in clinical development

SUMMARY

The understanding of pain transmission and modulation has improved considerably since the revolutionary gate control theory of Melzack and Wall in 1965. However, current pharmacological options, while effective for most patients, are not without their problems.

For example, the cardiovascular and renal toxicity associated with non-steroidal anti-inflammatory drugs recently delivered a huge blow to pain management. In addition, although opioids represent the most effective analgesic choice for most painful conditions, long-term opioid therapy is associated with potential hormonal and immunological consequences.

Nonetheless, major advances in the understanding of molecular and cellular mechanisms of pain have uncovered new potential pharmacological targets, although their clinical application is unlikely for several years. Several new products are in clinical development and promise to be potentially more effective and safer alternatives.

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