Identifying molecular mechanisms of acute to chronic pain transition and potential drug targets

ABSTRACT

Introduction

Chronic pain is pain that lasts more than the normal physiologic healing time at the time of initial insult. The transition from acute to chronic pain has been studied thoroughly. Understanding the mechanisms underlying chronic pain formation is essential for the development of novel treatments and therapeutics for chronic pain prevention.

Area covered

The transition from acute to chronic pain has been associated with the intracellular changes caused by repeated stimulus application, or neuronal priming, allowing for the chronicity of pain. Ongoing research studies have shown this priming to occur at various sites along the pathway for the neural transmission of pain. The purpose of this review is to not only elucidate the transition from acute to chronic pain and discuss current studies/trials related to this transition but also to highlight mechanisms involved in the process that could serve as potential targets for chronic pain prevention.

Expert opinion

We are providing an overview of novel treatment strategies for preventing the transition from acute to chronic pain. A multifaceted and multimodal approach that invokes multiple targets, at least one from each section (the periphery, the spinal cord, and the brain), would be the best option for tackling this problem.

KEYWORDS:

• Chronic postsurgical pain
• persistent postsurgical pain
• chronic pain
• transition of pain
• GABAAR
• NDMA/AMPA

Article highlights

• We should be cognizant that many chronic pain conditions evolve over time if poorly or incompletely treated in the initiation phases during the acute pain phase.

• The pathogenesis and mechanisms of chronic pain formation within the body is a complicated, multifactorial process.

• We deliberate the mechanisms at three different levels: the periphery, the spinal cord, and the brain.

• We discuss current studies or trials related not only to transition from acute to chronic pain but also the mechanisms involved in the process that could serve as potential targets for chronic pain prevention.

• In our opinion, a multifaceted and multimodal approach that invokes multiple targets, at least one from each section (the periphery, the spinal cord, and the brain), would be the best option for tackling this problem.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.