الفهرس 
Difinition and Types of PainOnly 14 pages are availabe for public view
 |  | from | 142 |  |  |
| | | from | 142 | | |
Abstract
lbroughout the past 20 yr, molecular biolo] ’ has expanded the
horizons of clinical medicine in both diagnosi, and treatment. A
background on a variety of molecular biology tl zhniques and their
application in genetic engineering and medicine hould facilitate an
understanding of the application of genetic techi iques in the daily
practice of clinical medicine .
Our enhanced understanding of the neurobie], ~y of pain and great
progress in molecular biologic technology, particul rly in gene therapy,
render a gene therapeutic approach to pain mal igement a realistic
possibility.
Gene therapy offers the tantalizing possibi ty of specific and
selective targeting of a single point in the synthesis of proteins. Current
gene therapy tools are promising but still require sigr ficant improvement
before routine human clinical application becomes a rality, CNS delivery
of antisense oligonucleotides as a means for reducir ~ the target protein
level is a technology on the verge of human clinical tri Is, and viral vectors
clearly will improve as the entire field of human ge re therapy evolves.
Animal work with state-of-the-art viral vectors conch lively demonstrates
the feasibility of tissue-specific and regulatable expre sion of transgenes.
Application of the tools and strategies of gene therapj to the field of pain
medicine may yield valuable therapies for the m nagement of pain
resistant to conventional pharmacotherapeutic options.
The process ofnociception involves intricate i ueractions between a
large number of cellular and molecular targets and i eludes many classes
of potential targets for gene therapy. We have pres’ ated only a selected
subset of targets that may be amenable to a gene the ipeutic approach for
attenuation of nociception; however, the strategies ; rd methods of gene
therapy may be applied to other current or future noci eptive targets.
Many gaps in our understanding of the roles 0 receptors and other
potential targets for gene therapy for pain exist. How ver, much is known
about the physiology, pharmacology, and molecular iiology of potential
therapeutic targets. Subsequent elucidation of the neur ibiology of pain and
progress in the tools available for gene therapy will ac ’ance the possibility
and reality of gene therapy for the management of lain. Strategies and
methods currently available for implementing ge e therapy for the
management of pain are not ideal but sufficiently elu idated for an initial
clinical trial. Anesthesiologists, by the virtue of au understanding and
intimate familiarity with the clinical problems of pa 1 management, are
situated particularly well to become the leaders in trar ilating the dramatic
• developments in the neurobiology of pain to clinic I gene therapy for
chronic pain management.