3 episode: slidgigt, lændesmerter og fibromyalgi

3 episode: osteoarthritis, lumbar pain and fibromyalgia

Osteoarthritis pain


  • Most common form of arthritis
  • Degenerative and inflammatory
  • Affects function (Affects hands, knees, hips…)
  • Pain
  • 62% are older people
  • Activation of local nociceptors
  • Sensitization of polymodal receptors in foreign areas of convergence with neurons at a general level with hyperalgesia.
  • Clients with radiographic alterations with or without pain
  • Sensitization in patients with pain without structural alterations.
  • Central sensitization and pain modulation

The sympathetic system innervates the synovial tissue, the periosteum, the medulla, and is related to the release of noradrenaline, which is an analgesic that helps adaptation.
Beta-blockers help to inhibit the beta-blockers (sympathetic system), therefore modulating the sympathetic system would reduce the consumption of analgesics and opioids.
and show evidence of reduced peripheral nervous system irritation and joint inflammation.
What we have to do? Massage? No, we have to stimulate the parasympathetic system, work with motor control,,,

Chronic low back pain


  • 70 -80% incidence
  • Primary hyperalgesia, result of peripheral receptor sensitization
  • Secondary hyperalgesia
  • Response of the central nervous system to low back pain decreases the sensitivity threshold because it increases the receptive fields, where the problem is in the malfunction of the descending inhibitory system of pain control, not the lumbar itself, therefore, our work should go in that sense.

There is evidence of increased central processing with components of idiopathic low back pain, the fact of sensitivity does not mean much in itself, but catastrophizing is a predictor of stress that will fuel the chronic pain loop and client disability.

Catastrofization is associated with low vagal variability and this is seen in cardiac variability, which predicts inflammatory responses, and ischemic processes.
We must also put into the equation of the process the client’s attitudes, their biopsychosocial environment, beliefs, thoughts, for example anxiety, which lowers the vagal tone.



  • 82% of clients present local symptoms before being fibromyalgic patients
  • Increases the excitability of the posterior horn of the medulla Increased pain response
  • Increased harmful stimuli  
  • Increased spontaneous activity
  • No tissue abnormalities


Nociceptive signaling in the spinal cord of patients with fibromyalgia is impaired by the facilitation of painful processes and by the ineffectiveness in the inhibition of these impulses.
We should consider the inhibition process in our treatments and stimulate them.
Could we stimulate the vagal, parasympathetic, limbic system to help these clients?
Could we stimulate vagal activity to improve core connectivity?
Cardiovascular alterations are also reflected in fibromyalgic clients.
So, what is the role of baroreceptors in all of this?
Why don’t we consider the cardiovascular system in patients with chronic pain?
There are connections between the vagal activity and the baroreflex system, and this system is a door to work with the vagal activity. Or not?
It is related to pain, with consciousness and pain modulation and intrinsic analgesia and stimulation of the descending inhibitory pathway.
We talk about all this in integrative therapy courses


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