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Front. Neurosci. | doi: 10.3389/fnins.2019.01268

Monoamines as drug targets in chronic pain: focusing on neuropathic pain

Lidia Bravo1, 2, 3, Meritxell Llorca-Torralba2, 3,  Esther Berrocoso2, 3, 4 and  Juan Antonio Micó1, 2, 3, 5*
  • 1Departamento de Neurociencias, Universidad de Cádiz, Spain
  • 2Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Universidad de Cadiz, Spain
  • 3Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
  • 4Department of Psychology, University of Cádiz, Spain
  • 5University of Cádiz, Spain

Monoamines are involved in regulating the endogenous pain system and indeed, peripheral and central monoaminergic dysfunction has been demonstrated in certain types of pain, particularly in neuropathic pain. Accordingly, drugs that modulate the monaminergic system and that were originally designed to treat depression are now considered to be first line treatments for certain types of neuropathic pain (e.g., serotonin and noradrenaline (and also dopamine) reuptake inhibitors). The analgesia induced by these drugs seems to be mediated by inhibiting the reuptake of these monoamines, thereby reinforcing the descending inhibitory pain pathways. Hence, it is of particular interest to study the monoaminergic mechanisms involved in the development and maintenance of chronic pain. Other analgesic drugs may also be used in combination with monoamines to facilitate descending pain inhibition (e.g., gabapentinoids and opioids) and such combinations are often also used to alleviate certain types of chronic pain. By contrast, while NSAIDs are thought to influence the monoaminergic system, they just produce consistent analgesia in inflammatory pain. Thus, in this review we will provide preclinical and clinical evidence of the role of monoamines in the modulation of chronic pain, reviewing how this system is implicated in the analgesic mechanism of action of antidepressants, gabapentinoids, atypical opioids, NSAIDs and histaminergic drugs.

Keywords: Chronic Pain, neuropathic pain, monoamines, Antidepressants, noradrenaline, Serotonin

Received: 31 May 2019; Accepted: 08 Nov 2019.

Copyright: © 2019 Bravo, Llorca-Torralba, Berrocoso and Micó. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Juan Antonio Micó, University of Cádiz, Cádiz, Spain, juanantonio.mico@uca.es