RESEARCH ARTICLE


Resiniferatoxin for Pain Treatment: An Interventional Approach to Personalized Pain Medicine



Michael J. Iadarola*, 1, 2, Gian Luigi Gonnella1, 3
1 Neurobiology and Pain Therapeutics Section, Laboratory of Sensory Biology, National Institute of Dental and Craniofacial Research, NIH
2 Building 49 Room 1C20, 49 Convent Drive MSC 4410, Bethesda MD 20892-4410, USA
3 Department of Anesthesiology and Intensive Care Medicine, Catholic University School of Medicine, Rome, Italy

Article Information


Identifiers and Pagination:

Year: 2013
Volume: 6
First Page: 95
Last Page: 107
Publisher ID: TOPAINJ-6-95
DOI: 10.2174/1876386301306010095

Article History:

Received Date: 8/08/2012
Revision Received Date: 8/08/2012
Acceptance Date: 16/08/2012
Electronic publication date: 08/3/2013
Collection year: 2013

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Creative Commons License
© 2013 Iadarola and Gonnella.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Building 49 Room 1C20, 49 Convent Drive MSC 4410, Bethesda MD 20892-4410; Tel: 301-496-2758; Fax: 301-402-0667; E-mail: christinemohn@hotmail.com


Abstract

This review examines existing preclinical and clinical studies related to resiniferatoxin (RTX) and its potential uses in pain treatment. Like capsaicin, RTX is a vanilloid receptor (TRPV1) agonist, only more potent. This increased potency confers both quantitative and qualitative advantages in terms of drug action on the TRPV1 containing nerve terminal, which result in an increased efficacy and a long duration of action. RTX can be delivered by a central route of administration through injection into the subarachnoid space around the lumbosacral spinal cord. It can also be administered peripherally into a region of skin or deep tissue where primary afferents nerves terminate, or directly into a nerve trunk or a dorsal root ganglion. The central route is currently being evaluated as a treatment for intractable pain in patients with advanced cancer. Peripheral administration offers the possibility to treat a wide diversity of pain problems because of the ability to bring the treatment to the site of the pain (the peripheral generator). While not all pain disorders are appropriate for RTX, tailoring treatment to an individual patient's needs via a selective and local intervention that chemically targets a specific population of nerve terminals provides a new capability for pain therapy and a simplified and effective approach to personalized pain medicine.

Keywords: Calcium Cytotoxicity, Osteosarcoma, Osteoarthritis, Dog, Cancer Pain, Geriatric, Ion Channel, Malignant Pain, Non-Malignant Pain, Spinal Stenosis, Complex Regional Pain Syndrome, Neuropathic Pain, C-Fibers, A-Delta Fibers, CGRP, Substance P, Mitochondria, Endoplasmic Reticulum, Plasma Membrane.