Microglia polarization in nociplastic pain: mechanisms and perspectives
Open accessAbstract
Nociplastic pain is the third classification of pain as described by the International Association for the Study of Pain (IASP), in addition to the neuropathic and nociceptive pain classes. The main pathophysiological mechanism for developing nociplastic pain is central sensitization (CS) in which pain amplification and hypersensitivity occur. Fibromyalgia is the prototypical nociplastic pain disorder, characterized by allodynia and hyperalgesia. Much scientific data suggest that classical activation of microglia in the spinal cord mediates neuroinflammation which plays an essential role in developing CS. In this review article, we discuss the impact of microglia activation and M1/M2 polarization on developing neuroinflammation and nociplastic pain, besides the molecular mechanisms engaged in this process. In addition, we mention the impact of microglial modulators on M1/M2 microglial polarization that offers a novel therapeutic alternative for the management of nociplastic pain disorders. Graphical abstract Illustrating the mechanisms underlying microglia activation in central sensitization and nociplastic pain. LPS lipopolysaccharide, TNF-α tumor necrosis factor-α, INF-γ Interferon gamma, ATP adenosine triphosphate, 49 P2Y12/13R purinergic P2Y 12/13 receptor, P2X4/7R purinergic P2X 4/7 receptor, SP Substance P, NK-1R Neurokinin 1 receptor, CCL2 CC motif ligand 2, CCR2 CC motif ligand 2 receptor, CSF-1 colony-stimulating factor 1, CSF-1R colony-stimulating factor 1 receptor, CX3CL1 CX3C motif ligand 1, CX3XR1 CX3C motif ligand 1 receptor, TLR toll-like receptor, MAPK mitogen-activated protein kinases, JNK jun N-terminal kinase, ERK extracellular signal-regulated kinase, iNOS Inducible nitric oxide synthase, IL-1β interleukin-1β, IL-6 interleukin-6, BDNF brain-derived neurotrophic factor, GABA γ-Aminobutyric acid, GABAR γ-Aminobutyric acid receptor, NMDAR N-methyl-D-aspartate receptor, AMPAR α-amino-3-hydroxy-5-methyl-4-isoxazolepropi-onic acid receptor, IL-4 interleukin-4, IL-13 interleukin-13, IL-10 interleukin-10, Arg-1 Arginase 1, FGF fibroblast growth factor, GDNF glial cell-derived neurotrophic factor, IGF-1 insulin-like growth factor-1, NGF nerve growth factor, CD Cluster of differentiation.
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Polarization of central glial cells contributes to NPP pathogenesis.
“In addition to activation, the polarization of central glial cells has also been reported to contribute to NPP pathogenesis of NPP (119).”
From Nociplastic pain: the prominent role of non-neuronal cells in central and peripheral sensitization (2026) · cites this paper as [119]
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“In addition to activation, the polarization of central glial cells has also been reported to contribute to NPP pathogenesis of NPP (119).”
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- Authors
- Atta, A. A., Ibrahim, W. W., Mohamed, A. F., & Abdelkader, N. F.
- Affiliations
- Cairo University (EG)
- Corresponding author
- Atta, Ahd A.
- Venue
- Inflammopharmacology
- Published
- 2023-04-17
- Volume
- 31
- Issue
- 3
- Pages
- 1053-1067
- ISSN
- 0925-4692 (ISSN-L)
- 1568-5608
- PMC
- PMC10229465
- OpenAlex
- W4366162633
- Cited by
- 178
- References
- 120
- Citations by year
- 2026: 62 · 2025: 67 · 2024: 38 · 2023: 11
- FWCI
- 6.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Inflammopharmacology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- Cairo University
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- nociplastic pain, microglial polarization, M1/M2 microglia, central sensitization, neuroinflammation, fibromyalgia, spinal cord, purinergic receptors, substance P, CCL2/CCR2, CSF1R, CX3CL1/CX3CR1, Toll-like receptors, MAPK signaling, inducible nitric oxide synthase, brain-derived neurotrophic factor, GABA receptors, NMDA receptor, AMPA receptors, therapeutic target, allodynia, hyperalgesia
- MeSH terms
- Neuroinflammatory Diseases, Humans, Hyperalgesia, Ligands, Lipopolysaccharides, Pain, Tumor Necrosis Factor-alpha, Interleukin-6, Macrophage Colony-Stimulating Factor, Microglia
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