ABSTRACT
Chronic pain is a common and debilitating ailment that affects over 80 million Americans each year at an estimated cost of estimated $61.2 billion per year in health expenditures and lost productivity (Stewart et al. 2003). In this chapter we will discuss the inadequacy of current pain therapeutics and present several classes of novel analgesics that modify glial cell function. In each of the following sections, we will present the preclinical and basic science research behind each class of therapeutic and the potential reality of their clinical use. We begin with a discussion of the failure of opioid therapy to adequately treat chronic pain populations and highlight serious side effects that only recently have come under scrutiny: for example, hormonal imbalances, hyperalgesia, heightened abuse, and diversion. Our laboratory’s focus on glial biology has begun to elucidate the role of these cells in both the mechanisms of some of these opioid side effects as well as primary glial effects related to their analgesic actions. Next, we will discuss the use of cannabinoids as analgesics and preclinical research that may increase their clinical efcacy by uncovering novel central nervous system (CNS) glial/immune mechanisms. Finally, we will end with a discussion of a new class of analgesics that has come directly out of basic science research, that is, more specic glial modulators.
