Quiñonez-Bastidas Geovanna Nallely, Grijalva-Contreras Lucia Elhy, Patiño-Camacho Selene Isabel, Navarrete Andrés
Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Eustaquio Buelna 91, Burócrata, Culiacan 80030, Mexico.
Programa de Licenciatura en Fisioterapia, Universidad Estatal de Sonora, Unidad Académica Hermosillo, Hermosillo 83100, Mexico.
Pharmaceuticals (Basel). 2024 Nov 30;17(12):1619. doi: 10.3390/ph17121619.
Trigeminal neuralgia (TN) is chronic pain caused by damage to the somatosensorial system on the trigeminal nerve or its branches, which involves peripheral and central dysfunction pain pathways. Trigeminal pain triggers disruptive pain in regions of the face, including within and around the mouth. Besides clinical experiences, translating the language of suffering into scientific terminology presents substantial challenges. Due to the complex and multifactorial pathophysiology underlying trigeminal pain, elucidating its social impact presents significant difficulties. Carbamazepine and oxcarbazepine are first-line treatments for TN, achieving approximately 50% pain reduction in 60-70% of treated patients. However, their efficacy is often limited by common side effects, such as dizziness, vertigo, nausea, seizures, and cognitive symptoms. In some cases, patients experience severe side effects, including myelosuppression, hyponatremia, hormonal imbalances, liver toxicity, suicidal ideation, teratogenicity, and other adverse reactions. Given these clinical limitations, the search for new painkiller candidates continues. Hence, we focused this review on salvinorin A (SalA), a natural agonist of κ-opioid receptors (KORs), which demonstrated anti-nociceptive, anti-inflammatory, and anti-neuropathic properties in various experimental models of the spinal sensory system. Furthermore, preclinical evidence indicates that SalA does not induce dependence and demonstrates a favorable toxicological and safety profile in comparison with currently marketed opioid drugs. We propose Salvinorin A as a promising candidate for treating trigeminal neuralgia, offering the potential for reduced adverse effects.
三叉神经痛（TN）是由三叉神经或其分支上的躯体感觉系统受损引起的慢性疼痛，涉及外周和中枢功能障碍性疼痛通路。三叉神经痛会引发面部区域的剧痛，包括口腔内及周围。除了临床经验，将痛苦的表述转化为科学术语也面临重大挑战。由于三叉神经痛背后复杂且多因素的病理生理学，阐明其社会影响存在显著困难。卡马西平和奥卡西平是三叉神经痛的一线治疗药物，在60 - 70%的接受治疗的患者中可使疼痛减轻约50%。然而，它们的疗效常常受到常见副作用的限制，如头晕、眩晕、恶心、癫痫发作和认知症状。在某些情况下，患者会出现严重副作用，包括骨髓抑制、低钠血症、激素失衡、肝毒性、自杀念头、致畸性及其他不良反应。鉴于这些临床局限性，寻找新的止痛药物候选物的工作仍在继续。因此，我们将本综述聚焦于Salvinorin A（SalA），一种κ-阿片受体（KORs）的天然激动剂，它在脊髓感觉系统的各种实验模型中表现出抗伤害感受、抗炎和抗神经病理性疼痛的特性。此外，临床前证据表明，与目前市场上销售的阿片类药物相比，SalA不会诱导成瘾，并且具有良好的毒理学和安全性。我们认为Salvinorin A是治疗三叉神经痛的一个有前景的候选药物，有可能减少不良反应。
