Antimicrobial therapies for chronic pain (part 1): analgesic mechanisms
Issued Date
2023-01-01
Resource Type
ISSN
20059159
eISSN
20930569
Scopus ID
2-s2.0-85165924291
Journal Title
Korean Journal of Pain
Volume
36
Issue
3
Start Page
281
End Page
298
Rights Holder(s)
SCOPUS
Bibliographic Citation
Korean Journal of Pain Vol.36 No.3 (2023) , 281-298
Suggested Citation
Wang E.J., Karri J., Tontisirin N., Cohen S.P. Antimicrobial therapies for chronic pain (part 1): analgesic mechanisms. Korean Journal of Pain Vol.36 No.3 (2023) , 281-298. 298. doi:10.3344/kjp.23129 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/88296
Title
Antimicrobial therapies for chronic pain (part 1): analgesic mechanisms
Author(s)
Other Contributor(s)
Abstract
There is increasing evidence that the relationship between chronic pain and infections is complex and intertwined. Bacterial and viral infections can cause pain through numerous mechanisms such as direct tissue damage and inflammation, the induction of excessive immunologic activity, and the development of peripheral or central sensitization. Treating infections might relieve pain by attenuating these processes, but a growing body of literature suggests that some antimicrobial therapies confer analgesic effects, including for nociceptive and neuropathic pain symptoms, and affective components of pain. The analgesic mechanisms of antimicrobials are indirect, but might be conceptualized into two broad categories: 1) the reduction of the infectious burden and associated pro-inflammatory processes; and 2) the inhibition of signaling processes (e.g., enzymatic and cytokine activity) necessary for nociception and maladaptive neuroplastic changes via off-target effects (unintended binding sites). For the former, there is evidence that symptoms of chronic low back pain (when associated with Modic type 1 changes), irritable bowel syndrome, inflammatory bowel disease, chronic pelvic pain, and functional dyspepsia might be improved after antibiotic treatment, though significant questions remain regarding specific regimens and dose, and which subpopulations are most likely to benefit. For the latter, there is evidence that several antimicrobial classes and medications exert analgesic effects independent of their reduction of infectious burden, and these include cephalosporins, ribavirin, chloroquine derivatives, rapalogues, minocycline, dapsone, and piscidin-1. This article aims to comprehensively review the existing literature for antimicrobial agents that have demonstrated analgesic efficacy in preclinical or clinical studies.