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Research ArticlePERSPECTIVES IN PHARMACOLOGY

Pharmacology of Opioid and Nonopioid Analgesics in Chronic Pain States

Thomas J. Martin and James C. Eisenach
Journal of Pharmacology and Experimental Therapeutics December 2001, 299 (3) 811-817;
Thomas J. Martin
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James C. Eisenach
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Abstract

Chronic pain represents a mixture of pathophysiologic mechanisms, a complex assortment of spontaneous and elicited pain states, and a somewhat unpredictable response to analgesics. Opioids remain the mainstay of treatment of moderate to severe chronic pain, although there is little systematic examination to guide drug selection. Cyclooxygenase inhibitors play primarily an adjunctive role in chronic pain treatment. Agents with little activity in the treatment of acute pain, such as antidepressants, antiepileptics, and i.v. administered local anesthetics, are initiated in many patients and have significant long-term efficacy in some patients with chronic pain. TheN-methyl-d-aspartate antagonist ketamine and the α2-adrenergic agonist clonidine exhibit activity in patients with acute or chronic pain and reduce opioid consumption, but are often poorly tolerated due to side effects. Topical treatment with capsaicin or lidocaine exhibits efficacy in a subset of patients, and invasive intrathecal treatment with opioids as well as clonidine, neostigmine, and adenosine may have advantages in some patients. Several laboratory models have been developed to mimic chronic pain states found in humans. Nerve injury has been induced in rats by a variety of means, resulting in mechanical allodynia and thermal hyperalgesia. A number of arthritic states have also been produced by means of chronic joint inflammation in rats. The pharmacology of these neuropathic and arthritic pain models generally resembles that found in the respective human conditions. Additional models of chronic pain, particularly visceral pain, have been developed; however, the pharmacology of these models is not well established at this time.

Footnotes

  • Supported in part by National Institutes of Health Grants GM35523 (J.C.E.) and NS38321 (T.J.M.).

  • Abbreviations:
    NMDA
    N-methyl-d-aspartate
    CCI
    chronic constriction injury
    COX
    cyclooxygenase
    GABA
    γ-aminobutyric acid
    PSL
    partial sciatic ligation
    SCN
    sciatic cryoneurolysis
    SNL
    spinal nerve ligation
    SNS
    sciatic nerve section
    • Received March 26, 2001.
    • Accepted July 6, 2001.
  • The American Society for Pharmacology and Experimental Therapeutics
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Journal of Pharmacology and Experimental Therapeutics: 299 (3)
Journal of Pharmacology and Experimental Therapeutics
Vol. 299, Issue 3
1 Dec 2001
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Research ArticlePERSPECTIVES IN PHARMACOLOGY

Pharmacology of Opioid and Nonopioid Analgesics in Chronic Pain States

Thomas J. Martin and James C. Eisenach
Journal of Pharmacology and Experimental Therapeutics December 1, 2001, 299 (3) 811-817;

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Research ArticlePERSPECTIVES IN PHARMACOLOGY

Pharmacology of Opioid and Nonopioid Analgesics in Chronic Pain States

Thomas J. Martin and James C. Eisenach
Journal of Pharmacology and Experimental Therapeutics December 1, 2001, 299 (3) 811-817;
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