Ciapała Katarzyna, Mika Joanna
Department of Pain Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Str., 31-343 Kraków, Poland.
Pharmaceuticals (Basel). 2023 Nov 17;16(11):1624. doi: 10.3390/ph16111624.
Neuropathic pain is a complex and debilitating condition that affects millions of people worldwide. Unlike acute pain, which is short-term and starts suddenly in response to an injury, neuropathic pain arises from somatosensory nervous system damage or disease, is usually chronic, and makes every day functioning difficult, substantially reducing quality of life. The main reason for the lack of effective pharmacotherapies for neuropathic pain is its diverse etiology and the complex, still poorly understood, pathophysiological mechanism of its progression. Numerous experimental studies, including ours, conducted over the last several decades have shown that the development of neuropathic pain is based on disturbances in cell activity, imbalances in the production of pronociceptive factors, and changes in signaling pathways such as p38MAPK, ERK, JNK, NF-κB, PI3K, and NRF2, which could become important targets for pharmacotherapy in the future. Despite the availability of many different analgesics, relieving neuropathic pain is still extremely difficult and requires a multidirectional, individual approach. We would like to point out that an increasing amount of data indicates that nonselective compounds directed at more than one molecular target exert promising analgesic effects. In our review, we characterize four substances (minocycline, astaxanthin, fisetin, and peimine) with analgesic properties that result from a wide spectrum of actions, including the modulation of MAPKs and other factors. We would like to draw attention to these selected substances since, in preclinical studies, they show suitable analgesic properties in models of neuropathy of various etiologies, and, importantly, some are already used as dietary supplements; for example, astaxanthin and fisetin protect against oxidative stress and have anti-inflammatory properties. It is worth emphasizing that the results of behavioral tests also indicate their usefulness when combined with opioids, the effectiveness of which decreases when neuropathy develops. Moreover, these substances appear to have additional, beneficial properties for the treatment of diseases that frequently co-occur with neuropathic pain. Therefore, these substances provide hope for the development of modern pharmacological tools to not only treat symptoms but also restore the proper functioning of the human body.
神经病理性疼痛是一种复杂且使人衰弱的病症,影响着全球数百万人。与急性疼痛不同,急性疼痛是短期的,因受伤而突然发作,神经病理性疼痛则源于躯体感觉神经系统的损伤或疾病,通常为慢性,会使日常功能变得困难,严重降低生活质量。缺乏针对神经病理性疼痛的有效药物疗法的主要原因是其病因多样,且其进展的病理生理机制复杂,仍未得到充分了解。在过去几十年中进行的众多实验研究,包括我们的研究,都表明神经病理性疼痛的发展基于细胞活动紊乱、伤害感受性因子产生失衡以及诸如p38丝裂原活化蛋白激酶(p38MAPK)、细胞外信号调节激酶(ERK)、c-Jun氨基末端激酶(JNK)、核因子κB(NF-κB)、磷脂酰肌醇-3激酶(PI3K)和核因子E2相关因子2(NRF2)等信号通路的变化,这些可能成为未来药物治疗的重要靶点。尽管有许多不同的镇痛药可供使用,但缓解神经病理性疼痛仍然极其困难,需要采取多方向的个体化方法。我们想指出的是,越来越多的数据表明,针对多个分子靶点的非选择性化合物具有有前景的镇痛作用。在我们的综述中,我们描述了四种具有镇痛特性的物质(米诺环素、虾青素、非瑟酮和浙贝母碱),它们的镇痛特性源于广泛的作用,包括对丝裂原活化蛋白激酶(MAPKs)和其他因子的调节。我们想提请注意这些选定的物质,因为在临床前研究中,它们在各种病因的神经病变模型中显示出合适的镇痛特性,而且重要的是,其中一些已被用作膳食补充剂;例如,虾青素和非瑟酮可抵御氧化应激并具有抗炎特性。值得强调的是,行为测试结果还表明,当与阿片类药物联合使用时它们很有用,而当神经病变发展时阿片类药物的有效性会降低。此外,这些物质似乎对治疗经常与神经病理性疼痛同时出现的疾病具有额外的有益特性。因此,这些物质为开发不仅能治疗症状而且能恢复人体正常功能的现代药理学工具带来了希望。
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