Update on peripheral mechanisms of pain: beyond prostaglandins and cytokines

Recent research and developmental strategy of anti-asthma drugs

Extensive research over the past decade has provided information about the pharmacotherapy of bronchial asthma (BA). Anti-asthma drugs are classified into two categories: relievers (for the relief of asthma attack symptoms) and controllers (for the prevention of asthma symptoms). This paper aims to review the recent advancements of anti-asthma drugs that are controller medicines. The controllers mainly act on immune and inflammatory responses in BA development. 1) Immunomodulators. Drugs that act on the immune response are classified into two categories: immunosuppressors and immunomodulators, including immunopotentiators. The immunomodulation of the Th1 and Th2 imbalance is the first strategy of the controller because allergic BA is thought to be caused by Th2-polarized immunity. Suplatast is a novel immunomodulator that can adjust the imbalance in the Th1/Th2 immune response and shows clear clinical efficacy against BA. The immunomodulator approach has shifted from a more theoretical and conceptual model to one supported by evidence of clinical efficacy.2) Anti-inflammatory agents. Corticosteroids,mast cell stabilizers and autacoid inhibitors are anti-inflammatory agents for BA. The clinical superiority of the combined therapy of inhaled corticosteroids and long-acting beta2 agonists is evident. This combined therapy shows a potent synergic anti-inflammatory effect compared to the effect by corticosteroids alone. Currently, the anti-inflammatory agents for BA under development are drugs affecting lipid mediators. The prostaglandin (PG) D2 antagonist, PGE2, EP3 agonist and PGI2 agonist are being considered in addition to well-established leukotriene and thromboxane A2 inhibitors. New development strategies and therapeutics for controllers are described in this review.

The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia

Pain is a key component of most rheumatologic diseases. In fibromyalgia, the importance of central nervous system pain mechanisms (for example, loss of descending analgesic activity and central sensitization) is well documented. A few studies have also noted alterations in central pain processing in osteoarthritis, and some data, including the observation of widespread pain sensitivity, suggest that central pain-processing defects may alter the pain response in rheumatoid arthritis patients. When central pain is identified, different classes of analgesics (for example, serotonin-norepinephrine reuptake inhibitors, α2δ ligands) may be more effective than drugs that treat peripheral or nociceptive pain (for example, nonsteroidal anti-inflammatory drugs and opioids).