Calcitonin as an analgesic agent: review of mechanisms of action and clinical applications

• Published in: Brazilian journal of anesthesiology (Elsevier) 2019-11, Vol.69 (6), p.594-604
• Main Authors: Yazdani, Javad, Khorshidi Khiavi, Reza, Ghavimi, Mohammad Ali, Mortazavi, Ali, Jabbari Hagh, Elahe, Ahmadpour, Farzin
• Format: Article
• Language: English
• Subjects: Acute pain; ANESTHESIOLOGY; Calcitonin; Calcitonina; Chronic pain; Diabetic neuropathies; Dor aguda; Dor crônica; Dor fantasma; Enxaqueca; Fraturas vertebrais; Malignancy; Malignidade; Migraine; Neuropatias diabéticas; Phantom pain; Review; Spinal fractures
• ISSN: 0104-0014; 1806-907X; 0104-0014; 1806-907X
• DOI: 10.1016/j.bjane.2019.08.003

Calcitonin is a polypeptide hormone regulating the metabolism of calcium in the body. For many years calcitonin has been used to maintain and improve bone mineral density and to reduce the fracture rate. Many studies showed that calcitonin had analgesic role in several painful circumstances. This pain-ameliorating effect is irrelevant to its osteoclastic inhibitory effect and mechanisms like altering Na+ channel and serotonin receptor expression or hypothesis including the endorphin-mediated mechanism were used to explain this effect. In this study we performed a thorough review on the role of calcitonin as an analgesic agent in different scenarios and investigated the fact that calcitonin can be a feasible medication to relieve pain. Many studies focused on the analgesic effect of calcitonin in several painful circumstances, including acute pains related to vertebral fractures, metastasis, migraine and reflex sympathetic dystrophy as well as neuropathic pains related to spinal injuries or diabetes, and phantom pain. Also, calcitonin was showed to be a useful additive to local anesthesia in the case of controlling postoperative pain or trigeminal neuralgia more effectively. However we faced some contradictory data for conditions like lumbar canal stenosis, complex regional pain syndrome, phantom pain and malignancies. This study showed that calcitonin could be helpful analgesic agent in different painful situations. Calcitonin can be considered an eligible treatment for acute pains related to vertebral fractures and a feasible alternative for the treatment of the acute and chronic neuropathic pains where other medications might fail. A calcitonina é um hormônio polipeptídico que regula o metabolismo do cálcio no organismo. Por muitos anos a calcitonina tem sido usada para manter e melhorar a densidade mineral óssea e reduzir a incidência de fraturas. Muitos estudos mostraram que a calcitonina teve efeito analgésico em várias condições físicas de dor. Esse efeito de melhoria da dor é irrelevante diante de seu efeito inibidor osteoclástico e de mecanismos, tais como a alteração do canal de Na+ e da expressão do receptor de serotonina, incluindo a hipótese do mecanismo mediado pela endorfina, que foram usados para explicar esse efeito. Neste estudo, fizemos uma revisão completa sobre o papel da calcitonina como agente analgésico em diferentes cenários e investigamos o fato de que a calcitonina pode ser uma medicação viável para aliviar a dor. Muitos estudos c