Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection
Transient receptor potential vanilloid type 1 (TRPV1), a ligand-gated cation channel, is a polymodal nocitransducer widely expressed within pain transmitting/modulating areas of the peripheral and central nervous system. TRPV1 is both activated and sensitized by inflammatory endogenous mediators during inflammatory pain conditions and appears to be up regulated in neuropathic pain conditions. Owing to its role as pain integrator, its widespread expression in pain neuraxis and its involvement in pain development TRPV1 offers an exciting opportunity for therapeutic interventions in pain management. In particular, its supraspinal expression within the antinociceptive descending pathway, which includes periaqueductal grey (PAG) and rostral ventromedial medulla (RVM), represents an endogenous switch for extinguishing pain in pathological conditions.