Antimicrobial therapies for chronic pain (part 2): the prevention and treatment of chronic pain

Eric J Wang; Edward Dolomisiewicz; Jay Karri; Nuj Tontisirin; Steven P Cohen

doi:10.3344/kjp.23130

Antimicrobial therapies for chronic pain (part 2): the prevention and treatment of chronic pain

Korean J Pain. 2023 Jul 1;36(3):299-315. doi: 10.3344/kjp.23130.

Authors

Eric J Wang¹, Edward Dolomisiewicz^{2

3}, Jay Karri⁴, Nuj Tontisirin⁵, Steven P Cohen^{1

2

6

7}

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA.
³ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁴ Departments of Orthopedic Surgery and Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁶ Departments of Physical Medicine & Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Abstract

The discovery and development of antimicrobial therapies represents one of the most significant advancements in modern medicine. Although the primary therapeutic intent of antimicrobials is to eliminate their target pathogens, several antimicrobials have been shown to provide analgesia as a secondary benefit. Antimicrobials have demonstrated analgesic effects in conditions that involve dysbiosis or potential subclinical infection (e.g ., chronic low back pain with Modic type 1 changes; chronic prostatitis/chronic pelvic pain; irritable bowel syndrome; inflammatory bowel disease; functional gastrointestinal disorders/dyspepsia; myalgic encephalomyelitis/chronic fatigue syndrome), and might even prevent the chronification of pain after acute infections that are associated with excessive systemic inflammation (e.g ., post COVID-19 condition/long Covid, rheumatic fever). Clinical studies often assess the analgesic effects of antimicrobial therapies in an observational manner, without the ability to identify causative relationships, and significant gaps in the understanding remain regarding the analgesic potential of antimicrobials. Numerous interrelated patient-specific, antimicrobial-specific, and disease-specific factors altogether contribute to the perception and experience of pain, and each of these requires further study. Given worldwide concerns regarding antimicrobial resistance, antimicrobials must continue to be used judiciously and are unlikely to be repurposed as primary analgesic medications. However, when equipoise exists among several antimicrobial treatment options, the potential analgesic benefits of certain antimicrobial agents might be a valuable aspect to consider in clinical decision-making. This article (the second in a two-part series) aims to comprehensively review the evidence on the prevention and treatment of chronic pain using antimicrobial therapies and suggest a framework for future studies on this topic.

Keywords: Analgesia; Anti-Bacterial Agents; Anti-Infective Agents; Antiviral Agents; Central Nervous System Sensitization; Chronic Pain; Infections; Neuralgia; Nociceptive Pain; Pain Management.

Publication types

Review

Grants and funding

FUNDING Dr. Cohen’s effort was funded in part by a grant from MIRROR, Uniformed Services University of the Health Sciences, U.S. Department of Defense, grant # HU00011920011. The views expressed in this article are those of the authors and do not necessarily reflect the official policy of the U.S. Department of Defense or the U.S. Government.