Oct 27, 2016

Antidepressants and gabapentinoids in neuropathic pain: Mechanistic insights

Neuroscience
Mélanie KremerMichel Barrot

Abstract

Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system. It is generally chronic and challenging to treat. The recommended pharmacotherapy for neuropathic pain includes the use of some antidepressants, such as tricyclic antidepressants (TCAs) (amitriptyline…) or serotonin and noradrenaline re-uptake inhibitors (duloxetine…), and/or anticonvulsants such as the gabapentinoids gabapentin or pregabalin. Antidepressant drugs are not acute analgesics but require a chronic treatment to relieve neuropathic pain, which suggests the recruitment of secondary downstream mechanisms as well as long-term molecular and neuronal plasticity. Noradrenaline is a major actor for the action of antidepressant drugs in a neuropathic pain context. Mechanistic hypotheses have implied the recruitment of noradrenergic descending pathways as well as the peripheral recruitment of noradrenaline from sympathetic fibers sprouting into dorsal root ganglia; and importance of both α2 and β2 adrenoceptors have been reported. These monoamine re-uptake inhibitors may also indirectly act as anti-proinflammatory cytokine drugs; and their therapeutic action requires the opioid system, particularly the mu (MOP) and/or delta (DO...Continue Reading

  • References207
  • Citations25

Citations

Mentioned in this Paper

Cannabinoids
Htr2a
Polyneuropathy
Establishment and Maintenance of Localization
Rgs9
Biochemical Pathway
Cyclic AMP-Responsive DNA-Binding Protein
Presynaptic Terminals
GRIN2B
Calcium [EPC]

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