Brigham and Women's Hospital, 75 Francis St., Anesthesia MRB, Boston, MA 02115, USA.
Anesth Analg. 2010 Mar 1;110(3):780-9. doi: 10.1213/ANE.0b013e3181cde882.
Fifty-nine drugs identified as analgesics were introduced from 1960 to 2009 and remain in use. Seven can be regarded as having novel molecular targets; however, only one, sumatriptan, was sufficiently effective to motivate the introduction of many similar drugs acting at the same target (triptans). Publication productivity in the area of pain grew exponentially during this period. Pain-related publications on morphine were dominant among other analgesics. Very intensive research efforts directed at diverse molecular targets related to pain mechanisms produced thousands of publications, but those efforts have not yet yielded new analgesics with sufficient effectiveness to change the share of publications on opioids or nonsteroidal antiinflammatory drugs. Morphine and aspirin, introduced for the treatment of pain more than a century ago, continue to dominate biomedical publications despite their limited effectiveness in many areas (e.g., neuropathic pain) and multiple serious adverse effects. The present assessment reveals the lack of real breakthroughs in analgesic drug development despite intense research efforts. Possible factors contributing to the apparent drought of novel analgesics are discussed.
从 1960 年到 2009 年，有 59 种被确定为镇痛药的药物被引入并仍在使用。其中有 7 种可以被视为具有新的分子靶点；然而，只有一种，舒马曲坦，因其足够有效而促使许多作用于同一靶点（曲坦类药物）的类似药物被引入。在这期间，疼痛领域的相关出版物呈指数级增长。吗啡相关的出版物在其他镇痛药中占据主导地位。针对与疼痛机制相关的不同分子靶点的非常密集的研究产生了数千篇出版物，但这些努力尚未产生新的镇痛药，其有效性足以改变阿片类药物或非甾体抗炎药的出版物份额。吗啡和阿司匹林在一个多世纪前就被引入用于治疗疼痛，尽管它们在许多领域（如神经性疼痛）的效果有限且存在多种严重的不良反应，但它们在生物医学出版物中仍然占据主导地位。目前的评估表明，尽管进行了大量研究，但在镇痛药物开发方面仍缺乏真正的突破。讨论了导致新型镇痛药明显短缺的可能因素。
