Figure 1.

Neuronal activity in physiological and sensitization processes. The figure schematically shows the antithetic processes and relative outcomes occurring in physiological (Php) and neurological sensitization process (NSp) after that a stimulus (noxious stimuli, inflammation, wound, trauma) activates the nociceptive afference (box A). Physiologically, antidromic activation of C fibers, the so-called neuorogenic inflammation, and specific autonomic efferences (box B) sustain peripheral healing process restoring both homeostasis and physiological ongoing interoceptive-centrifugal communication between periphery and CNS (box C_Php). In the right column (pink boxes) lacking of resolution of peripheral inflammation sustains nociceptive afference with a consecutive amplification of centrifugal phenomena (boxes C_NSp – D_NSp) that can become maladaptive or neurotoxic, see Xanthos and Sandkuhler for details (Xanthos and Sandkühler, 2014). Maintenance of this metabolic-neurological TISSUE-CNS vicious cycle (box E_NSp)could bring to PS (1) and CS (2) as well as to a never-ending self-maintenance inflammation state (3) (box F_NSp). Several therapies (box F_NSp), including OMT, could be theoretically administered to solve neurological sensitization in different clinical conditions where PS and/or CS are present. CNS, central nervous system; ANS, autonomic nervous system; PS, peripheral sensitization; CS central sensitization; SP, substance P; CGRP, calcitonin gene-related peptide; ATP, adenosine triphosphate; BDNF, brain-derived neurotrophic factor; NPY, neuropeptide Y; SOM, somatostatin; CB, cannabinoid; DAMP, danger associated molecular patterns; OMT, osteopathic manipulative treatment; NSAIDs, non-steoridal anti-inflammatory drugs; CAM, complementary alternative medicine.