Miclescu, A. 1,2; Gordh, T.
(1)Department of Surgical Sciences/Anesthesiology and
Intensive Care Medicine, Uppsala University Hospital, Uppsala,
(2)Pain Clinic, Uppsala University Hospital, Uppsala,
Nitric oxide and pain: 'Something old, something
Acta Anaesthesiologica Scandinavica.
53(9):1107-1120, October 2009.
: Challenges have emerged following
the revival of nitric oxide (NO) from 'something old', a simple gas
derived from nitrogen and oxygen with a role in the early stages of
evolution, into 'something new', an endogenously formed biological
mediator regulating a wide variety of physiological functions.
Although pain is a common sensation, it encompasses multiple
neurobiologic components, of which NO is only one.
In pain research,
the study of NO is complicated by convoluted problems related mostly
to the effects of NO, which are pro- or anti-nociceptive depending on
the circumstances. This dual function reflects the multi-faceted
roles of the NO molecule described in physiology. This review covers
current information about NO and its implications in pain mechanisms.
In addition, it follows the pain pathways, demonstrating the role of
NO in peripheral nociceptive transmission as well in central
sensitization. This knowledge may provide the scientific basis for
developing new drugs that are indicated for different types of pain,
drugs that may be related to the chemical links of NO.
comprehensive approach to understanding the effects of NO will help
clinicians identify novel agents that combine the pharmacological
profile of native drugs with a controllable manner of NO release.
Inhibitors of NO synthesis may have analgesic effects and would be of
interest for treating inflammatory and neuropathic pain.
Unfortunately, only a few of these compounds have reached the stage
of clinical pain trials.
(C) 2009 The Acta Anaesthesiologica