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Treating skeletal pain: limitations of conventional anti-inflammatory drugs, and anti-neurotrophic factor as a possible alternative

Nature Clinical Practice Rheumatology volume 5, pages 92–98 (2009)Cite this article

Abstract

Inflammatory and injury-induced skeletal pain are common conditions, and both conventional nonselective NSAIDs and the newer cyclo-oxygenase-2-specific inhibitors are widely used as post-traumatic and post-surgical analgesics. However, new research suggests that these drugs, particularly the cyclo-oxygenase-2 inhibitors, have a negative effect on the healing process in fractured bone and within orthopedic surgical sites, thus highlighting a need to develop new approaches for managing skeletal pain. Various experimental studies have revealed that locally upregulated neurotrophic factors, especially nerve growth factor, have a major role in mediating injury-induced or inflammatory pain. Nerve growth factor inhibitors, therefore, might be an effective alternative modality for post-traumatic and post-surgical analgesia, without impairing bone healing.

Key Points

  • Nonselective NSAIDS and, more recently, specific cyclo-oxygenase-2 inhibitors are commonly used as post-traumatic and post-surgical analgesics

  • The inhibitory effects of these drugs on bone fracture healing highlights a need to develop new approaches for managing skeletal pain

  • Neurotrophic factors, particularly nerve growth factor, have a major role in mediating injury-induced or inflammatory pain of the skeleton

  • Nerve growth factor inhibitors could represent an attractive and effective alternative approach to relieving skeletal pain resulting from trauma, injury or bone cancer, without compromising bone healing and remodeling

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Figure 1: Potential functions and mechanisms of action of NGF in the development of post-injury pain.

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Acknowledgements

The authors wish to thank NHMRC Australia for funding their senior research fellowships and project grants.

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Authors and Affiliations

  1. and X-F Zhou is a Senior Research Fellow and a Research Professor at the Centre for Neuroscience and the Department of Human Physiology, CJ Xian is a Senior Research Fellow and Associate Professor at the Sansom Institute of Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Flinders University, Adelaide, SA, Australia.,

    Cory J Xian & Xin-Fu Zhou

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Correspondence to Cory J Xian.

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Xian, C., Zhou, XF. Treating skeletal pain: limitations of conventional anti-inflammatory drugs, and anti-neurotrophic factor as a possible alternative. Nat Rev Rheumatol 5, 92–98 (2009). https://doi.org/10.1038/ncprheum0982

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