Future pain drugs. 8-9 March 2000, London, UK

Closing the gaps between product design and delivery of analgesic drugs, and individual patient needs for pain relief was the focus for this meeting. The changes in theories of nociceptive activity, from a mechanistic to a biopsychosocial disorder with diverse systemic modulation, were highlighted by Mark Travers (Janssen-Cilag, Titusville, NJ, USA), including examples from clinical trials where a patient's expectations were not met and high drop-out rates occurred. The need to target drug design and delivery to defined patient groups was clearly an important issue. The potential for drug delivery systems, such as polymer matrix and transmucosal applications, was discussed. Analogs of naturally occurring compounds that interact with nociceptive systems are creating opportunities for novel antinociceptive and anti-hyperalgesic peptides. The never-ending discovery of new pain transmission and transduction mechanisms fuels the potential for synthesis of more compounds. In reality, the multifactorial nature of pain, with its large potential commercial market in hospitals and within the community, demands a similar multidimensional approach to pain therapies. Much of the emerging preclinical data suggest that interactions between the processes of nociception and the modulatory, inhibitory, immune and inflammatory systems that may generate or maintain nociceptive activity, may be important for the future development of therapeutics in pain management. Such data are being generated through studies with, for example: the tripeptides, vanilloid, galanin and neuropeptide Y receptor ligands; the pharmacological effects of sumatriptan (Glaxo Wellcome plc); and, the serotonin and norepinephrine selective antidepressant, venlafaxine (Effexor XR; Wyeth-Ayerst International Inc).