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Secondary hyperalgesia is a phenomenon that refers to sensitization that occurs within thecentral nervous system9. Repeated recruitment of C-fibers following an injury will producecentral sensitization by changing the respose properties of the membranes of secondaryneurons. This will result in an increase of the firing rate, a phenomenon known as windup10.The high frequency recruitment of C fibers, either by increased repetitive stimuli or by a tonicstimulation11, will induce an increase of the perceived pain, even if the intensity of thestimulation remains constant. The spinal sensitization can persist for minutes, but can also bepresent for hours and even days12. The prolonged activation of the NMDA receptors willinduce the transcription of rapidly expressed genes (c-fos, c-jun), resulting in sensitization ofnociceptors. This neuronal plasticity of the secondary neuron will result in a reduced thresholdin the spinal cord, producing hyperalgesic and allodynic responses that may persist even afterthe healing of the injury. Considering the impact of sensitization, an aggressive and earlytreatment plan to reduce pain will help in preventing ongoing chronic pain6.
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