Abstract | November 17, 2023

Developmental Approaches to Chronic Pain

Nikita Patel, B.S., Medical Student, OMS-III, KPCOM, Davie, FL

Chad Bates, B.S., Medical Student, OMS-III, KPCOM, Davie, FL

Learning Objectives

  1. Upon completion of this lecture, learners should be better prepared to explain the progression of acute pain to chronic pain.
  2. Upon completion of this lecture, learners should be better prepared to explain the various developmental approaches to chronic pain that are currently under investigation.
  3. Upon completion of this lecture, learners should be better prepared to explain the benefits and risks associated with opioid and NSAID usage as it relates to acute and chronic pain analgesia.

Background/Knowledge Gap: Chronic pain is a pathological development from acute pain and persists for greater than three months with minimal relief. Chronic pain has historically been treated with NSAIDs and opioids, however both treatment options carry risks for organ injury and/or addiction. Although chronic pain is a persistent problem in society, there are currently limited treatment options; therefore, there exists a need to develop alternative treatment options for chronic pain that mitigate the risks associated with opioid usage. Throughout this paper, we will attempt to fill in the knowledge gap that currently exists by describing the current developmental approaches that are under investigation.

Methods/Design: All the data collected, reviewed, and discussed were collected using published peer-reviewed journal articles from PubMed. The information provided in this review was not limited to a specific time frame.

Results/Findings: Studies have shown that LIM kinase and RGS4 inhibition have the potential to increase delta-opioid receptor (DOR) trafficking to the plasma membrane. Preclinical studies have shown that modulation of IL-17 cytokine release from Th1 and Th17 cells produced visible reduction in mice paw flinches and mechanical allodynia. Additionally, preclinical studies on mice showed that knock-out deletion of sodium channels Na+ 1.7 and Na+ 1.8 was able to produce a significant reduction in pain perception. Targeting intracellular TIMP-1 and MMP, was shown in mice models to reduce mechanical hypersensitivity through modulation of pro-inflammatory chemokine, cytokines, and extracellular proteins. Lastly, utilization of Glairamer Acetate (GA) in preclinical trials, resulted in reduced microglial activation, decreased allodynia, and increased IL-10 producing CD4+ cells in the dorsal horn.

Conclusions/Implications: Chronic pain is a significant problem, however modern medicine has provided minimal compensation for the complex nature that is pain perception, processing, and integration. Therefore, alternative mechanisms to provide analgesia are currently being researched and developed. Although preclinical trials have shown promise, additional research is still needed to further assert safety, efficiency, and long-term consequences of treatment.

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