Muthuraman Arunachalam, Singh Nirmal, Jaggi Amteshwar Singh, Ramesh Muthusamy
Department of Pharmaceutical Sciences & Drug Research, Faculty of Medicine, Punjabi University, Patiala 147002, Punjab (India).
Curr Drug Targets. 2014 Feb;15(2):210-53.
Understanding mechanism of neuropathic pain is too complex and involves both peripheral and central pathophysiological phenomenon. Accordingly the treatment of neuropathic pain is also very complex and is unsatisfactory. The present review attempts to discuss the currently employed pharmacological agents for the management of neuropathic pain including anti-depressants, anti-convulsants, NMDA receptor antagonists, topical & local anesthetics, and upload analgesics. However, the existing pharmacotherapy has marginal efficacy and significant side effects. The review also gives an insight into various pharmacological agents with potential neuropathic pain attenuating properties in experimental models that include NSAIDs, corticosteroids, ion channel blockers (Ca(2+), Na(+), K(+), and TRP channel); ion exchange modulators (NCE and NHE); ion/molecule transport modulators (NKCC-1 and glycine); receptor modulators (kinin, histamine, 5-HT1A, dopamine, alpha & beta adrenergic, purinergic, excitatory amino acid, sigma, ORL1, endothelin, melanocortin, ephrin and PAR); enzyme inhibitors (cytosolic kinase, metalloproteinase, protease, vasopeptidase, D-amino acid oxidase, fatty acid amide hydrolase, aldose reductase and sorbitol dehydrogenase); other ligands (AGE, RAGEs, neuropeptides, neurotrophic factor, complement cascade, cytokine, glial cell & gap junction, nitrous oxide, growth factor, cell adhesion molecule and neuronal sprouting molecule). Moreover, some advanced therapeutic approaches such as neuronal cell transplantation, stem cell therapy, anti-sense oligonucleotide and recombinant therapy have also been dicussed.
理解神经性疼痛的机制过于复杂，涉及外周和中枢病理生理现象。因此，神经性疼痛的治疗也非常复杂且不尽人意。本综述试图讨论目前用于治疗神经性疼痛的药物，包括抗抑郁药、抗惊厥药、NMDA受体拮抗剂、局部及局部麻醉药和阿片类镇痛药。然而，现有的药物治疗效果有限且副作用显著。该综述还深入探讨了在实验模型中具有潜在减轻神经性疼痛特性的各种药物，包括非甾体抗炎药、皮质类固醇、离子通道阻滞剂（钙、钠、钾和瞬时受体电位通道）；离子交换调节剂（新型化合物和钠氢交换体）；离子/分子转运调节剂（钠钾氯协同转运蛋白-1和甘氨酸）；受体调节剂（激肽、组胺、5-羟色胺1A、多巴胺、α和β肾上腺素能、嘌呤能、兴奋性氨基酸、西格玛、孤啡肽FQ、内皮素、黑皮质素、ephrin和蛋白酶激活受体）；酶抑制剂（胞质激酶、金属蛋白酶、蛋白酶、血管肽酶、D-氨基酸氧化酶、脂肪酸酰胺水解酶、醛糖还原酶和山梨醇脱氢酶）；其他配体（晚期糖基化终末产物、晚期糖基化终末产物受体、神经肽、神经营养因子、补体级联、细胞因子、胶质细胞和缝隙连接、一氧化氮、生长因子、细胞粘附分子和神经元发芽分子）。此外，还讨论了一些先进的治疗方法，如神经元细胞移植、干细胞治疗、反义寡核苷酸和重组治疗。
