Full Professor at the Federal University of Maranhão / Brazil. Head of the Pain and Palliative Care Service at the Maranhao Cancer Hospital. Active member of the Brazilian Society of Anesthesiology, Brazilian Society for the Study of Pain (of which he was President for the biennium 2011-2012) and National Academy of Palliative Care, now President-elect(2025-2027) . President of the Latin American Federation of Associations for the Study of Pain achieving excellent recognition in the countries of this region, where maintain undisputed leadership in the field of pain. IASP (International Association for the Study of Pain) Counsellor(2014-2020). Currently a member of the WFSA Pain Committee. Researcher and author of numerous articles published in national and high impact international journals, chapters of books and conferences in the area of pain and palliative care around the world.
EDUCATION
Anesthesiologist, Pain and Palliative Care specialist. PhD in Medicine in the area of Pain by the Federal University of São Paulo.
Therapeutic Potential of Ambroxol in Osteoarthritis: A Drug Repurposing Study Michelline Joana Tenório Albuquerque Madruga Mesquita, Anne Caroline Silva Nogueira da Cruz, Joana Tenório Albuquerque Madruga Mesquita Meireles Teixeira, Amanda Tissore Forwille Reis, Gustavo Medeiro Frota, et al. Pharmaceuticals, 2026 Background/Objectives: Ambroxol is a mucolytic agent widely used in the treatment of respiratory diseases; however, evidence in the literature indicates anti-inflammatory, analgesic, and immunomodulatory properties, suggesting potential for therapeutic repositioning. This study aimed to evaluate the analgesic and anti-inflammatory effects of ambroxol in an experimental model of osteoarthritis (OA). Methods: Adult male Wistar rats underwent OA induction on day zero (D0) by sodium monoiodoacetate (MIA) injection and were allocated into the following groups: Healthy, negative control (CTRL−), and groups treated with meloxicam (2 mg/kg) or ambroxol (10, 50, and 100 mg/kg). Treatments were administered orally (gavage) once daily for 28 days. Behavioral tests were performed, including rotarod, walkway gait analysis, weight-bearing, Von Frey, and Rat Grimace Scale assessments, along with radiographic and histopathological analyses and quantification of pro- and anti-inflammatory cytokines (IL-1β, IL-6, and IL-10). Results: Ambroxol treatment improved nociceptive parameters and motor function, reduced radiographic and histopathological scores, and showed performance comparable to meloxicam in several tests. There was a marked reduction in IL-1β and IL-6 levels, while IL-10 levels were lower in ambroxol-treated groups, suggesting early control of the inflammatory response. Conclusions: The results indicate that ambroxol exhibits antinociceptive and anti-inflammatory actions and suggest a potential chondroprotective effect, reinforcing its viability as a candidate for therapeutic repositioning in osteoarthritis. Further studies are required to more precisely elucidate its mechanisms of action, define optimal dosing and treatment duration, and support translation to clinical models.
Analgesic and Anti-Inflammatory Activity of Ambroxol in the Treatment of Endometriosis: An Experimental Study in Wistar Rats Gustavo Medeiros Frota, Wilwana Guimarães Barbalho Santos, Joana Tenório-Meireles, Eduardo Rodrigues Silva, Amanda Tissore Forwille Reis, et al. Pharmaceuticals, 2026 Background/Objective: This study evaluated the analgesic and anti-inflammatory effects of ambroxol in an experimental model of endometriosis. Methods: Ambroxol was administered at doses of 10, 50, and 100 mg/kg (Abx 10, Abx 50, and Abx 100) by daily gavage for 21 days. A medroxyprogesterone-treated group (Progesterone) was included as a positive control. Pain was assessed using validated behavioral tests, including the Rat Grimace Scale (RGS), the von Frey test, and the rotarod test. Additionally, interleukin-1β (IL-1β) levels and total leukocyte counts were measured in peritoneal lavage fluid. The volumetric reduction in endometriotic implants was evaluated by ultrasonography, while histopathological analysis characterized inflammatory infiltrate and epithelial layer integrity using a standardized scoring system. Results: All ambroxol doses reduced spontaneous pain manifestations throughout the treatment. The mechanical withdrawal threshold significantly increased from the second week onward, and motor quality improved over the course of the study. A significant reduction in IL-1β levels compared with the negative control (Control(−)) was observed on day 21. Abx 50 and Abx 100 significantly reduced implant volumes (48.2% and 56.2%, respectively) and promoted marked disruption of the endometriotic epithelial layer. When compared with Progesterone, higher doses—particularly 100 mg/kg—demonstrated comparable efficacy. Conclusions: Taken together, these pleiotropic effects support the potential for drug repurposing in endometriosis.
Non-Pulmonary Mechanisms of Action of Ambroxol in In Vivo Experimental Models: a Systematic Review Michelline Joana Tenório Albuquerque Madruga Mesquita, Anne Caroline Silva Nogueira da Cruz, Rafael de Abreu Lima, Joana Tenório‐Meireles, Arney José Nogueira Farias, et al. Fundamental and Clinical Pharmacology, 2026 Background Repositioning offers a cost‐effective approach to discovering new therapeutic applications for existing medications. Ambroxol, primarily used as a mucolytic for respiratory diseases, has demonstrated anti‐inflammatory, analgesic, and antioxidant properties, suggesting potential benefits in non‐pulmonary conditions. This study conducted a systematic review to evaluate the efficacy of ambroxol in experimental disease models unrelated to the respiratory system. Methods Following registration in the Open Science Framework and adherence to the PICO strategy for formulating the guiding question, searches were performed in PUBMED/MEDLINE, EMBASE, and SCOPUS using the keywords: (Ambroxol) AND (Anti‐Inflammatory Agents OR Analgesics OR Antioxidants) AND (Animals OR in vivo). The SYRCLE tool assessed methodological quality. Among 353 identified records, eight articles met eligibility criteria. Results These studies investigated ambroxol's effects in models of gastric lesions, neuropathic pain, psoriasis‐like skin inflammation, hemorrhagic cystitis, and ischemia/reperfusion injuries in the liver and kidneys. Ambroxol doses ranged from 5 to 1000 mg/kg, predominantly administered orally. Its antioxidant properties were demonstrated by reducing free radicals and increasing enzymatic activity (SOD, CAT, GSH). Anti‐inflammatory effects included a decrease in pro‐inflammatory cytokines (TNF‐α, IL‐1β) and histological improvements. Antinociceptive action was observed through inhibition of voltage‐gated sodium channels and reduction of oxidative stress, alleviating neuropathic pain. Conclusions Despite ambroxol's widespread clinical use, limited research has explored its non‐respiratory applications. Existing studies suggest its promising therapeutic potential, reinforcing the need for further investigation into its role as an alternative treatment for various inflammatory and oxidative stress–related conditions beyond pulmonary diseases.
When Nerves Speak Louder Than Blood: Investigating TRPV1 Gene Polymorphisms in Neuropathic Pain Related to Sickle Cell Disease Camila Freitas de Andrade Rodrigues, Thiago Alves Rodrigues, João Batista Santos Garcia Anemia, 2026 Background Pain is a common symptom and a cause of hospitalization in patients with sickle cell disease (SCD). Traditionally linked to vaso‐occlusive crises and categorized as acute and nociceptive, this perspective does not reflect the complexity of pain in this population, which includes pain with neuropathic features caused by lesions or dysfunctions in the somatosensory nervous system. Ion channels such as transient receptor potential vanilloid 1 (TRPV1), involved in neuropathic pain mechanisms, play a role in nociceptive transduction and can be affected by genetic variants. This study examined the prevalence of neuropathic pain in patients with SCD and its link to TRPV1 gene polymorphisms, combining clinical and genetic data to develop a comprehensive understanding of pain in this population. Methods A cross‐sectional study included 84 patients followed at a hematology center in Northeast Brazil. Neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) questionnaire, and four TRPV1 polymorphisms (rs224534, rs222747, rs8065080, and rs222749) were genotyped using standard PCR. Results Neuropathic pain was present in 36.9% of participants and was significantly associated with age over 34 years, self‐identification as Black, and a higher number of pain episodes in the past year ( p < 0.05). Patients with three or more episodes were nine times more likely to have neuropathic pain. There were no differences in gender, opioid use, or hospitalizations. None of the analyzed polymorphisms showed an association with neuropathic pain. Conclusion Neuropathic pain is a common and underrecognized feature of SCD. Although no association was observed between the evaluated TRPV1 polymorphisms and neuropathic pain, these findings do not exclude a role for TRPV1 and likely reflect the multifactorial nature of pain in SCD. Further studies using genetic approaches and larger samples are warranted to elucidate the mechanisms underlying neuropathic pain.
Mapping the Scientific Landscape of Neuropathic Pain in Sickle Cell Disease: A Two-Decade Bibliometric Perspective on an Underexplored Challenge Camila Freitas de Andrade Rodrigues, Thiago Alves Rodrigues, Lucas Gabriel Feitosa da Exaltação, João Batista Santos Garcia Anemia, 2026 Background Neuropathic pain is often underdiagnosed and undertreated in individuals with sickle cell disease (SCD), particularly in regions where the disease is prevalent. Despite its significant impact on quality of life and the healthcare system, the extent to which this issue has been explored in the scientific literature remains unclear. This study aimed to conduct the first bibliometric analysis focused on neuropathic pain in SCD, identifying global research trends, key contributors, and critical knowledge gaps. Methods We searched the Web of Science, Scopus, PubMed, SciELO, and LILACS for publications from the past 20 years. Article selection followed PRISMA guidelines. Bibliometric analysis was performed using Bibliometrix and VOSviewer software. Results Thirty‐seven studies met the inclusion criteria, revealing a limited body of research on this topic. Publications originated from seven countries, with the United States being the most productive. Research output showed a modest increase from 2019 to 2021. The most common keywords included “children,” “management,” and “questionnaire,” highlighting a clinical and pediatric‐oriented trend. Notably, “children” was not a search descriptor but an emerging keyword from the bibliometric analysis. Institutional and geographic concentration was evident, with the University of Illinois Chicago leading in productivity. Conclusions This study highlights a significant gap between the clinical importance of neuropathic pain in SCD and the limited scientific interest it has received worldwide. The few publications emphasize the urgent need for coordinated, multicenter efforts—especially in high‐prevalence areas—to advance research, enhance clinical outcomes, and address disparities in care.
Latin American Guide of Clinical Practice for the treatment of massive hemorrhage in palliative patients in terminal situation Revista Mexicana De Anestesiologia, 2018
Optimizing post‐operative pain management in Latin America João Batista Santos Garcia, Patricia Bonilla, Durval Campos Kraychete, Fernando Cantú Flores, Elizabeth Diaz Perez de Valtolina, et al. Brazilian Journal of Anesthesiology, 2017
Xenotransplantation of uterine leiomyoma in Wistar rats: A pilot study Willane Bandeira de Sousa, João Batista Santos Garcia, João Nogueira Neto, Pablo Gustavo Ribeiro Furtado, Jonhnathan Adriano Araújo dos Anjos European Journal of Obstetrics and Gynecology and Reproductive Biology, 2015
Prevalence of low back pain in Latin America: A systematic literature review Pain Physician, 2014
Neurotoxicity of subarachnoid preservative-free S (+)-ketamine in dogs Pain Physician, 2011
Opioid-Induced Hyperalgesia (OIH) Plínio da Cunha Leal, Jefferson Clivatti, João Batista Santos Garcia, Rioko Kimiko Sakata Revista Brasileira De Anestesiologia, 2010
Intraperitoneal administration of 50% enantiomeric excess (S75-R25) bupivacaine in postoperative analgesia of laparoscopic cholecystectomy Revista Brasileira De Anestesiologia, 2007
Pain: Current aspects on peripheral and central sensitization Anita Perpétua Carvalho Rocha, Durval Campos Kraychete, Lino Lemonica, Lídia Raquel de Carvalho, Guilherme Antônio Moreira de Barros, et al. Revista Brasileira De Anestesiologia, 2007
