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Pain’s pathway and the drugs that block it

Defining Pain PAIN SNIPERS


The pain sensation originates as a chemical soup of The newest analgesics are far more specific
than aspirin or narcotics, taking aim only at
signals emitted by pain-sensing nerve endings called THALAMUS THALAMUS certain pain-causing cellular mechanisms.
nociceptors. These signals travel through the network
of peripheral 3 3 NERVE CELL
ACTIQ Anesta
AXON A crystallized narcotic on a stick,
nerves that (CARRIES IMPULSE The pain signal approved in November, that offers quick
run through- TO MOTOR NEURONS)
NEUROTRANSMITTERS CEREBRAL radiates from relief for breakthrough cancer pain.
out the body CORTEX a nerve cell CELEBREX, VIOXX Monsanto, Merck
to the cen- CELL
into the spinal Arthritis treatments just reaching the market
BODY
tral nervous NOCICEPTORS INSULATING cord that block pain and inflammation without the
system, the (RECEIVE PAIN IMPULSE) SHEATH SACS SYNAPSE AXON stomach-damaging effects of aspirin-like drugs.
brain, and NOCICEPTORS NEURONTIN Warner-Lambert
spinal cord. 2

PHOTOGRAPHS BY (NERVE CELL) PATRICK MANTYH; (SNAIL) NORBERT WU/PETER ARNOLD ;


An epilepsy drug in clinical trials for chronic
There they gather in the dorsal horn, a 4 neuropathic pain. It targets a neurotransmitter
that controls both pain and nerve excitability.
site in the spinal cord that acts as a
clearinghouse for pain messages. The ZICONOTIDE Neurex
signals are transmitted into the brain’s Based on the venom of a sea snail,
it blocks pain signals from entering
thalamus, which sorts them and passes the spinal cord. Neurex will file for
them on to the cerebral cortex, where FDA approval this year.
the pain is actually “felt.”
2 MORPHIDEX Algos Pharmaceutical
VENTRAL NERVE ROOT (TOWARDS BRAIN) By blocking secondary pain sensors, the drug

(FROG) MARION BACON/ANIMALS ANIMALS


CENTRAL CANAL allows morphine to be twice as effective without
increasing side effects. Algos filed for FDA
approval in August.
ABT-594 Abbott Laboratories
DORSAL HORN
Based on a toxin in the skin of a rain-
forest frog, it prevents the central
DORSAL NERVE ROOT (INTO SPINAL CORD)
1 nervous system from processing pain
signals. In early human trials.
DORSAL HORN

ACUTE PAIN 4
Sharp, immediate pain comes from an injury CHRONIC PAIN
to tissue but can also be triggered by bodily Persistent, debilitating pain, such as that from
malfunction or severe illness. a bad back or diseases of the nerves themselves,
Nociceptors in the peripheral nerves takes a more circuitous route.
1 sense the injury and in response, Pain signals enter the dorsal horn of
release chemical messengers. 1 the spinal cord…
The messengers travel through … and transfer back and forth between
2 superfast nerve conduits to the spinal 2 interconnected nerves that modulate the
cord, where… pain message as it travels up the spinal cord…
… they are passed directly to the …to the cerebral cortex, which assesses
3 thalamus and into the cerebral cortex. 3 the damage and adjusts emotions and
The brain precisely identifies the site other bodily functions, such as breathing.
4 of the injury and sends a message back
1 This slower pathway creates duller, more
down the spinal column telling the muscles 4 persistent pain. If the pain persists, the
to contract and block the pain. The process entire nervous system may be reprogrammed
can take place in the instant that your finger to create a lower threshold for pain.
touches a hot stove and pulls away.
BUSINESS WEEK / MARCH 1, 1999 105

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