Toll-like receptors (TLRs) have been shown to play an important role in the immune system, which warrants their remarkable pharmacological potentials. Activation of TLRs requires participation from specific PAMPs (pathogen associated molecular patterns) and accessory proteins such as MD2 (myeloid differentiation protein 2), LBP (lipopolysaccharide binding protein), and CD-14. Assembly of the TLR4-MD2-LPS complex is essential in TLR4 activation. Recent studies have revealed that TLR4 activation is a significant trigger of signal transmission pathways in the nervous system, which could result in chronic pain as well as opioid tolerance and dependence. Researchers of the molecular structure of TLRs and their accessory proteins have opened a door to syntheses of TLRs agonists and antagonists, such as Eritoran. Small molecule modulators of TLR4, such as MD2-I and tricyclic anti-depressants, offer more promising prospects than peptides for their convenient oral usage and lower cost. We mainly discuss the mechanism and clinical prospect of TLR4 agonists and antagonists in this review.