Arachidonic acid pathways in nociception

The metabolism of arachidonic acid may follow multiple, inter-related pathways, leading to the generation or release of a wide variety of biologically active substances (including bradykinins, serotonin, histamine, prostaglandins, and cytokines) that produce pain and/or inflammation. Therapeutic agents that directly affect one particular pathway, such as cyclooxygenase inhibitors (typically, nonsteroidal anti-inflammatory agents), may indirectly affect one or more other pathways, as well as the resolution of inflammation. Rather than taking the traditional approach to treating multiple types of pain by inhibiting a single pathway, future treatments of pain and inflammation may target specific pathways and pain mechanisms and/or address two or more pathways simultaneously. A thorough understanding and appreciation of the mechanisms contributing to various pain and inflammatory states, the metabolic fates of arachidonic acid, the functions of its many metabolites, and the interrelatedness of the various metabolic pathways involved in nociception may lead to more rational and optimal approaches to addressing patient suffering.