title: Resiniferatoxin for Pain Treatment: An Interventional Approach to Personalized Pain Medicine.
abstract: This review examines existing preclinical and clinical studies related to resiniferatoxin (RTX) and its potential uses in pain treatment. Like capsaicin, RTX is a vanilloid receptor (TRPV1) agonist, only more potent. This increased potency confers both quantitative and qualitative advantages in terms of drug action on the TRPV1 containing nerve terminal, which result in an increased efficacy and a long duration of action. RTX can be delivered by a central route of administration through injection into the subarachnoid space around the lumbosacral spinal cord. It can also be administered peripherally into a region of skin or deep tissue where primary afferents nerves terminate, or directly into a nerve trunk or a dorsal root ganglion. The central route is currently being evaluated as a treatment for intractable pain in patients with advanced cancer. Peripheral administration offers the possibility to treat a wide diversity of pain problems because of the ability to bring the treatment to the site of the pain (the peripheral generator). While not all pain disorders are appropriate for RTX, tailoring treatment to an individual patient's needs via a selective and local intervention that chemically targets a specific population of nerve terminals provides a new capability for pain therapy and a simplified and effective approach to personalized pain medicine.
authors.affiliation: Neurobiology and Pain Therapeutics Section, Laboratory of Sensory Biology, National Institute of Dental and Craniofacial Research, NIH; Building 49 Room 1C20, 49 Convent Drive MSC 4410, Bethesda MD 20892-4410, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Iadarola
authors.affiliation: Neurobiology and Pain Therapeutics Section, Laboratory of Sensory Biology, National Institute of Dental and Craniofacial Research, NIH; Department of Anesthesiology and Intensive Care Medicine, Catholic University School of Medicine, Rome, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Gonnella
keywords: A-delta fibers; C-fibers; CGRP; Calcium cytotoxicity; Substance P; arachnoiditis; cancer pain; complex regional pain syndrome; dog; endoplasmic reticulum; geriatric; ion channel; malignant pain; mitochondria; neuropathic pain; non-malignant pain; osteoarthritis; osteosarcoma; plasma membrane; spinal stenosis