Neuraxial Therapeutics in Pain Management: Present and Future

The neuraxial delivery of drugs has become a cornerstone in the management of pain, leveraging the pivotal roles of the dorsal root ganglion (DRG) and dorsal horn. These spinal structures are key in processing pain-related messages from tissue and nerve injuries, primary and secondary hyperalgesia, and chronic pain phenotypes that persist even after initial injuries heal. This intricate interplay involves not just sensory-discriminative encoding but also the higher-order affective aspects of pain, engaging regions like the hypothalamus, amygdala, and hippocampus.

Neuraxial interventions show significant therapeutic efficacy in managing both acute and chronic pain by targeting the underlying biological pathways at the spinal level. Specific pharmacological targeting of these pathways can profoundly affect pain intensity and the emotional experience of pain. Hence, this approach is promising for conditions where systemic side effects are a concern or where blood-brain barrier limitations exist.

We invite submissions of basic, clinical, and preclinical research, as well as reviews, focusing on:

Key Areas of Interest:

Device Design and Efficacy: Innovations in catheter, port, and pump designs that enhance local redistribution, therapeutic efficacy, efficiency, and safety.

Delivery Formulations: Advances in formulations that influence the bioavailability and pharmacokinetics of neuraxial therapeutics.

Toxicity and Safety: Impact of therapeutics on toxicity and safety at their targets.

Complex Pain Behaviors: Assessment of neuraxial analgesics on complex pain behaviors and phenotypes.

Higher Order Function Changes: Non-invasive imaging and electrophysiology studies evaluating the effects of neuraxial treatments on nociceptive processing.

Distribution Factors: Factors affecting the delivery of intrathecal and epidural molecules to the DRG, meninges, CSF, and spinal parenchyma.

Preclinical Studies: Research targeting spinal pain biology via intrathecal routes.

Clinical Trials: Well-powered and controlled trials reflecting neuraxial therapeutic effects across various pain states.

We look forward to groundbreaking contributions that advance our understanding and implementation of neuraxial therapeutics in pain management.