Glial Modulator Antibiotics for Neuropathic Pain: Current Insights and Future Directions

Pathological pain is defined as pain that outlives its usefulness as a protective warning system and becomes debilitating, disrupting normal life function. Understanding the mechanism of transition from physiological to pathological pain is essential to provide the effective prevention of chronic pain. The main subcategories of pathological pain are nociceptive pain, neuropathic pain, and nociplastic pain. Glial cells play pivotal roles in the development and maintenance of each of these pathological pain states, specifically neuropathic pain. Consequently, targeting these cells has emerged as a promising therapeutic strategy, as limited efficacy and harmful adverse effects are associated with current pharmacotherapies. This paper aims to review specific antibiotics that modulate glial cells, which can be used to treat neuropathic pain. These antibiotics include minocycline, doxycycline, ceftriaxone, and azithromycin. The potential of these antibiotics appears promising, particularly given the extensive prior research and use of these antibiotics in humans for other illnesses. However, each presents its own set of limitations, ultimately making the translation from preclinical findings to human therapies for neuropathic pain challenging.