Endocannabinoid System and Its Therapeutic Effects in Pain Management

The endocannabinoid system (ECS) is a biological system composed of endocannabinoids, which are endogenous lipid-based retrograde neurotransmitters that bind to cannabinoid receptors, and cannabinoid receptor proteins that are expressed throughout the mammalian central nervous system (including the brain) and peripheral nervous system. The endocannabinoid system is involved in regulating a variety of physiological and cognitive processes including fertility, pregnancy, during pre- and postnatal development, appetite, pain-sensation, mood, and memory, and in mediating the pharmacological effects of cannabis. The ECS is also involved in mediating some of the physiological and cognitive effects of voluntary physical exercise in humans and other animals, such as contributing to exercise-induced euphoria as well as modulating locomotor activity and motivational salience for rewards. Two primary endocannabinoid receptors have been identified: CB1, first cloned in 1990; and CB2, cloned in 1993. CB1 receptors are found predominantly in the brain and nervous system, as well as in peripheral organs and tissues, and are the main molecular target of the endocannabinoid ligand (binding molecule), anandamide, as well as its mimetic phytocannabinoid, THC. One other main endocannabinoid is 2-arachidonoylglycerol (2-AG) which is active at both cannabinoid receptors, along with its own mimetic phytocannabinoid, CBD. 2-AG and CBD are involved in the regulation of appetite, immune system functions and pain management. Cannabinoids are pharmacological agents of endogenous (endocannabinoids), botanical (phytocannabinoids), or synthetic origin. Cannabinoids alleviate pain through a variety of receptor and non-receptor mechanisms including direct analgesic and anti-inflammatory effects, modulatory actions on neurotransmitters, and interactions with endogenous and administered opioids. Basic science and clinical trials support the theoretical and practical basis of cannabinoid agents as analgesics for chronic pain. Their unique pharmacological pro fi les with multimodality effects and generally favorable efficacy and safety profiles render cannabinoid-based medicines promising agents for adjunctive treatment, particularly for neuropathic pain. It is our expectation that the coming years will mark the advent of numerous approved cannabinoids with varying mechanisms of action and delivery techniques that should offer the clinician useful new tools for treating pain.

کلیدواژه ها:

endocannabinoid system ، Cannabinoids ، Pain Management