Treating Skeletal Pain: Limitations of Conventional Anti-inflammatory Drugs, and Anti-neurotrophic Factor as a Possible Alternative

Cory J. Xian; Xin-Fu Zhou


Nat Clin Pract Rheumatol. 2009;5(2):92-98. 

In This Article


Both conventional and COX-2-specific NSAIDS are important components in the management of pain after skeletal trauma or surgery. The limitations associated with these agents, including a possible role in the impairment of fracture healing, highlight the need to develop new modalities of pain management. Neurotrophic factors, particularly NGF, have been shown to mediate injury-induced or inflammatory pain of the skeleton, and studies have demonstrated that anti-NGF therapy could represent an attractive and effective alternative to NSAIDs, without compromising bone healing and remodeling. Further studies are required to understand how NGF and other neurotrophic factors, and their receptors, mediate pain evoked by injury, surgery, chronic inflammation, or cancer of the skeletal system. Questions remain regarding the cellular sources of the neurotrophic factors at or near the pain epicenter, and the molecular mechanisms of pain development. In addition, future studies are needed to evaluate or develop more-effective analgesic agents, based on the neuropathic roles of neurotrophic factors with minimal interference of their normal physiological neurotrophic functions and their functions in tissue and bone healing. More preclinical and clinical studies are needed to determine the role of these potential new modalities in clinical practice.

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