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Peripheral mechanisms Peripheral mechanisms help us understand what happens in the body tissues when they are injured and how they respond to long term damage. The initial skin response to mild injury includes redness, local swelling and pain. This is known as a ‘triple response’ or a ‘flare reaction’ and is caused by changes in local skin blood flow producing the colour change, and the release of inflammatory chemicals which cause tissue swelling or a wheal. The benefit of capsaicin or ‘chilli’ ointment treatment depends on the reduction of this inflammatory response. Direct activation of the small skin nerves involved in pain transmission occurs due to this ‘inflammatory soup’ which develops in the damaged tissues  and which amplifies the pain signal and accellerates the inflammatory responses. Secondary activation due to progressive release of more powerful inflammatory chemicals from skin cells, platelets and mast cells further ‘up regulate’ the small fibre acitivity responsible for pain signals, increase the nerve activity and pain signals by reducing the threshold for for pain sensation. The heat sensitivity of skin is reduced which produces ‘burning’ pain at normal body temperature to further increase the pain signals to be processed by the spinal cord.
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click to see  larger image triple response of Lewis