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Nevertheless, as the role of the TRPA channels as well as possible roles of other TRP channels in producing or maintaining sensitization of trigeminal dural afferent nerves are elucidated, the potential for development of novel, selective, and safer medications against migraine may be realized.
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Furthermore, there seems to be a state of maintained sensitization of trigeminal nociceptive systems in the brain.
That the brainstem plays a relevant role in mediating and maintaining central sensitization was recently confirmed by functional neuroimaging studies in healthy humans [45, 46].
Ectopic spontaneous activity plays an important role in maintaining central sensitization and neuropathic pain.
Because nociceptive input from muscles is very powerful in inducing and maintaining central sensitization [ 74], FM muscle abnormalities may strongly contribute to pain through important mechanisms of pain amplification.
To induce and maintain central sensitization, NMDA receptors (NMDAR) play an important role (Woolf and Thompson 1991).
However, increasing evidence points towards peripheral tissues as relevant contributors of painful impulse input that might either initiate or maintain central sensitization, or both.
This is important because maintained central sensitization is thought to be characteristic of many chronic pain states where light touch or moderately painful stimulation can cause excruciating pain (Schmelz, 2009).
For instance, in both diseases, it has been shown that primary and secondary hyperalgesia are maintained by central sensitization, through tonic nociceptive input from peripheral afferents [ 39, 40].
Our data suggest that the OA joint exhibits increased sensitivity to the pronociceptive effects of CGRP and that this increased CGRP receptor signaling acts to maintain joint nociceptor sensitization.
Activation and sensitization of dural afferents likely occur resulting in release of mediators that maintain the sensitized state and sustain pain.
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