Pharmacotherapy for neuropathic pain: progress and prospects

Neuropathic pain, a persistent chronic pain resulting from damage to the central or peripheral pain signaling pathway, has become an area of intense research activity--largely because it represents a disorder with high unmet medical need. It is not a single disease entity, but rather includes a range of heterogeneous conditions that differ in etiology, location and initiating cause. Despite this diversity, the clinical presentation is frequently surprisingly similar, which suggests a common biological basis. Until recently, little was known of the mechanisms underlying the various neuropathic pain conditions, making the directed development of novel therapies almost impossible. However, the steady increase in our understanding of the anatomical, cellular and molecular basis of neuropathic pain, coupled with the advent of a number of experimental models of neuropathy, has permitted relatively rapid progress, and the prospects for the emergence of new, more effective therapies look very good. Gabapentin (Pfizer), which appears to act by blocking calcium channels, is the first drug to acquire widespread regulatory approval for the treatment of neuropathic pain. The Society for Medicines Research symposium held June 26, 2003, considered this treatment modality alongside other approaches to therapy, such as N-methyl-D-aspartate receptor antagonists and cannabinoid receptor agonists. The whole meeting provided an excellent description of the challenges facing neuropathic pain drug discovery--at both the research and the development phases of the value chain.