Marijuana has been used to relieve
pain for centuries. The analgesic mechanism of its constituents, the
cannabinoids, was only revealed after the discovery of
cannabinoid receptors (CB1 and CB2) two decades ago. The subsequent identification of the
endocannabinoids,
anandamide and
2-arachidonoylglycerol (2-AG), and their biosynthetic and degradation
enzymes discloses the therapeutic potential of compounds targeting the
endocannabinoid system for
pain control. Inhibitors of the
anandamide and 2-AG degradation
enzymes,
fatty acid amide hydrolase and monoacylglycerol
lipase, respectively, may be superior to direct
cannabinoid receptor ligands as
endocannabinoids are synthesized on demand and rapidly degraded, focusing action at generating sites. Recently, a promising strategy for
pain relief was revealed in the periaqueductal gray (PAG). It is initiated by
Gq-protein-coupled receptor (Gq PCR) activation of the
phospholipase C-
diacylglycerol lipase enzymatic cascade, generating 2-AG that produces inhibition of GABAergic transmission (disinhibition) in the PAG, thereby leading to
analgesia. Here, we introduce the antinociceptive properties of exogenous
cannabinoids and
endocannabinoids, involving their biosynthesis and degradation processes, particularly in the PAG. We also review recent studies disclosing the Gq PCR-
phospholipase C-diacylglycerol lipase-2-AG retrograde disinhibition mechanism in the PAG, induced by activating several Gq PCRs, including metabotropic glutamatergic (type 5
metabotropic glutamate receptor), muscarinic
acetylcholine (M1/M3), and
orexin 1 receptors. Disinhibition mediated by type 5
metabotropic glutamate receptor can be initiated by
glutamate transporter inhibitors or indirectly by
substance P,
neurotensin,
cholecystokinin and
capsaicin. Finally, the putative role of 2-AG generated after activating the above
neurotransmitter receptors in stress-induced
analgesia is discussed.