2. Academic Validation
  3. Status of peripheral sodium channel blockers for non-addictive pain treatment

Status of peripheral sodium channel blockers for non-addictive pain treatment

  • Nat Rev Neurol. 2020 Dec;16(12):689-705. doi: 10.1038/s41582-020-00415-2.
Matthew Alsaloum 1 2 3 4 5,  Grant P Higerd 1 2 3 4,  Philip R Effraim 2 3 6,  Stephen G Waxman 7 8 9
Affiliations

Affiliations

  • 1 Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
  • 2 Center for Neuroscience & Regeneration Research, Yale University, West Haven, CT, USA.
  • 3 Center for Rehabilitation Research, VA Connecticut Healthcare System, West Haven, CT, USA.
  • 4 Yale Medical Scientist Training Program, Yale School of Medicine, New Haven, CT, USA.
  • 5 Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA.
  • 6 Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA.
  • 7 Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. stephen.waxman@yale.edu.
  • 8 Center for Neuroscience & Regeneration Research, Yale University, West Haven, CT, USA. stephen.waxman@yale.edu.
  • 9 Center for Rehabilitation Research, VA Connecticut Healthcare System, West Haven, CT, USA. stephen.waxman@yale.edu.
PMID: 33110213 DOI: 10.1038/s41582-020-00415-2
Abstract

The effective and safe treatment of pain is an unmet health-care need. Current medications used for pain management are often only partially effective, carry dose-limiting adverse effects and are potentially addictive, highlighting the need for improved therapeutic agents. Most common pain conditions originate in the periphery, where dorsal root ganglion and trigeminal ganglion neurons feed pain information into the CNS. Voltage-gated sodium (NaV) channels drive neuronal excitability and three subtypes - NaV1.7, NaV1.8 and NaV1.9 - are preferentially expressed in the peripheral nervous system, suggesting that their inhibition might treat pain while avoiding central and cardiac adverse effects. Genetic and functional studies of human pain disorders have identified NaV1.7, NaV1.8 and NaV1.9 as mediators of pain and validated them as targets for pain treatment. Consequently, multiple NaV1.7-specific and NaV1.8-specific blockers have undergone clinical trials, with Others in preclinical development, and the targeting of NaV1.9, although hampered by technical constraints, might also be moving ahead. In this Review, we summarize the clinical and preclinical literature describing compounds that target peripheral NaV channels and discuss the challenges and future prospects for the field. Although the potential of peripheral NaV channel inhibition for the treatment of pain has yet to be realized, this remains a promising strategy to achieve non-addictive analgesia for multiple pain conditions.

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