Mechanisms of pain and analgesia.
An opportunity to develop a new generation of methods for pain relief has arisen from recent advances in the neurobiology of pain. A variety of sensitive and reliable pain assessment methods are now available to facilitate clinical trials. Assessment tools that are suitable for young children are being developed, making analgesic research feasible in this group of patients.New analgesic methods may either block the action of neurochemical mediators of pain or promote endogenous pain-relieving systems. Treatments aimed at preventing peripheral nerve sensitization by inflammatory products avoid the side effects of centrally acting narcotic analgesics. Endogenous opioid systems are involved in the body's analgesic response to acute pain and stress. Pituitary beta-endorphin release is a likely component of this response and may be manipulated by pharmacological interventions. Noradrenergic and serotonergic pain-inhibiting systems may mediate the specific analgesia produced by amitriptyline in neuropathic pain states.
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