{"id":1648,"date":"2015-08-15T06:11:57","date_gmt":"2015-08-15T06:11:57","guid":{"rendered":"https:\/\/andreasphysioblog.com\/?p=1648"},"modified":"2021-05-04T05:17:12","modified_gmt":"2021-05-04T05:17:12","slug":"indlaeg-om-kemisk-smerteforstaelse-central-sensibilitering-mekanoreceptorer-og-nociceptorer","status":"publish","type":"post","link":"https:\/\/andreasphysioblog.com\/?p=1648","title":{"rendered":"Indl\u00e6g om kemisk smerteforst\u00e5else; Central sensibilitering, mekanoreceptorer og nociceptorer."},"content":{"rendered":"<h1><strong>Indl\u00e6g om kemisk smerteforst\u00e5else; Central sensibilitering, mekanoreceptorer og nociceptorer.<br \/>\n<\/strong><\/h1>\n<p>Dette blogindl\u00e6g bygger p\u00e5 artiklen\u00a0Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain (2013), Dean, J. L\u00e6s her:Dean 2013 why does my shoulder hurt: Skrev for at f\u00e5 stuidet eller request for the study on <a href=\"http:\/\/www.reseachgate.com\/\" rel=\"nofollow\">http:\/\/www.reseachgate.com<\/a><\/p>\n<p><img decoding=\"async\" class=\" wp-image-5603 alignright\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-52-54.png?w=232&amp;h=198\" sizes=\"(max-width: 232px) 100vw, 232px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-52-54.png?w=232&amp;h=198 232w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-52-54.png?w=464&amp;h=394 464w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-52-54.png?w=150&amp;h=127 150w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.52.54\" width=\"232\" height=\"198\" data-attachment-id=\"5603\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-15-52-54\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-52-54.png\" data-orig-size=\"474,402\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.52.54\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-52-54.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-52-54.png?w=474\" \/>N\u00e5r vi taler om smerte, s\u00e5 er\u00a0der ofte ikke ensidig biomekinsk \u00e5rsag til smerterne. Vi har brug for at forst\u00e5 flere omkringliggende faktorer for symptomerne. Denne model kaldes den biopsykosociale model hvilket der er flere gode blogindl\u00e6g omkring andre steder. Se <a href=\"http:\/\/www.smertespecialisterne.dk\/?p=234\">her<\/a> og <a href=\"http:\/\/simonkirkegaard.dk\/den-biomedicinske-smertemodel-vs-biopsykosociale-smertemodel\/\">her<\/a>.<\/p>\n<p>Det vi kort vil beskrive her er:<\/p>\n<ul>\n<li>(1) de perifere receptorer<\/li>\n<li>(2)\u00a0Den perifere smerte\u00a0proces:<\/li>\n<li>(3)\u00a0Spinal cord \/\u00a0Central sensitisation<\/li>\n<li>(4) hjernen,<\/li>\n<li>(5) Overvejelser i diagnosticering<\/li>\n<\/ul>\n<p><strong>Grundl\u00e6ggende smerte:<\/strong><\/p>\n<h1><strong>1) Perifere sensoriske receptorer<\/strong>: <strong>Mekanoreceptor og nociceptorer<\/strong>.<\/h1>\n<p><strong>-Ceptorer<\/strong><br \/>\n<img decoding=\"async\" class=\" wp-image-5636 alignleft\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png?w=256&amp;h=146\" sizes=\"(max-width: 256px) 100vw, 256px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png?w=256&amp;h=146 256w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png?w=512&amp;h=292 512w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png?w=150&amp;h=86 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png?w=300&amp;h=171 300w\" alt=\"Sk\u00e6rmbillede 2015-08-17 kl. 19.53.40\" width=\"256\" height=\"146\" data-attachment-id=\"5636\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-17-kl-19-53-40\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png\" data-orig-size=\"868,496\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-17 kl. 19.53.40\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-53-40.png?w=825\" \/>Der findes mange typer af perifere sensoriske receptorer og de reagere p\u00e5 forskellige stimuli s\u00e5som mekanik, temperaturer eller kemi.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Der er fart p\u00e5:<\/strong><\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\" wp-image-5602 alignright\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png?w=270&amp;h=243\" sizes=\"(max-width: 270px) 100vw, 270px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png?w=270&amp;h=243 270w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png?w=540&amp;h=484 540w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png?w=150&amp;h=134 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png?w=300&amp;h=269 300w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.51.03\" width=\"270\" height=\"243\" data-attachment-id=\"5602\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-15-51-03\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png\" data-orig-size=\"694,622\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.51.03\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-51-03.png?w=694\" \/>Disse perifere sensoriske receptorer er afferente nerver er af varierende omfang og med forskellig myelinskede st\u00f8rrelse, hvilket g\u00f8r at de sender fyring med forskellig hastighed.<br \/>\nDeres forskellige egenskaber opdeles i tre grupper:<\/p>\n<ul>\n<li>En tyk myeliniserede nerve group II \/ A\u03b2 fibres (&gt;20 m\/s),<\/li>\n<li>En smal myeliniserede nerve A\u03b2 fibres III \/ A\u03b4 fibres (2.5\u2013 20 m\/s)<\/li>\n<li>en ikke myeliniserede nerver group IV eller C fibres (&lt;2.5 m\/s)<\/li>\n<\/ul>\n<p>De forskellige typer af receptor kan derefter subklassificeres p\u00e5 baggrund af deres\u00a0kemiske respons.\u00a0S\u00e5kaldte nociceptorer reagere p\u00e5 et skadelige stimuli med en h\u00f8j t\u00e6rskel og kan ogs\u00e5 reagere p\u00e5 flere stimuli former s\u00e5som termiske, mekaniske og kemiske stimuli.<\/p>\n<p><strong>Nociception<\/strong><\/p>\n<p>P\u00e5 molekyl\u00e6rt niveau kan nociceptorer enten v\u00e6re peptidergic eller ikke-peptidergic afh\u00e6ngig af hvorvidt peptiderne sidder i de dorsale horn i rygmarven.<br \/>\nPeptiderne omfatter substans P (SP), calcitonin-relateret peptid (CGRP) og somatostatin. Det er kompleks at underklassificerer nociceptorer uden at tage h\u00f8jde for funktion og den kemisk plasticitet der reguleres af \u00e6ndringer fra bev\u00e6gelse, inflammation og skader.\u00a0Det vigtigt at bem\u00e6rke, at nociception ikke ses som en smertereceptorer. I<em>\u00a0IASP Pain Terminology fra 2008 skrives det\u00a0Nociceptor er \u201cA sensory receptor that is capable of transducing and encoding noxious stimuli\u201d<\/em>, s\u00e5 det er alts\u00e5 ikke smerte endnu, men et neuralt signal.<\/p>\n<p><strong>Mekanoception<\/strong><\/p>\n<p>Mechanoreceptor er en anden afferent sensorisk receptor der\u00a0sender information om de mekaniske stimuli til centralnervesystemet. De stimuli\u00a0for mekanoreceptoreren omfatter hud-stimulus, vibrationer, str\u00e6k og ber\u00f8ring. Blandt andet er mekanoreceptorerne vigtig i\u00a0<a href=\"https:\/\/andreasbjerregaard.wordpress.com\/2015\/06\/09\/skulder-proprioception-traening-med-laser-pointer\/\">propriocept<\/a>ion\u00a0der giver stillingssans information omkring\u00a0muskler og led.<\/p>\n<p>Mekanoreceptorer kan klassificeres som low-threshold mekanoreceptors (LTMs) eller high-threshold mekanoreceptors (HTMs), fordi de reagerer p\u00e5 forskellige stimuli. Som med nociceptorer, er de forskellige typer af mekanoreceptorer forbundet med specifikke afferente nerve. Ved HTMs mekeanoreceptorer vil der v\u00e6re en grad af lighed\/crossover mellem nociceptorer og mekanoceptorer pga deres made at reagere p\u00e5.<\/p>\n<p><a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-5601\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=640&amp;h=158\" sizes=\"(max-width: 640px) 100vw, 640px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=640&amp;h=158 640w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=1280&amp;h=316 1280w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=150&amp;h=37 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=300&amp;h=74 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=768&amp;h=190 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=1024&amp;h=253 1024w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.38.57\" width=\"640\" height=\"158\" data-attachment-id=\"5601\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-15-38-57\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png\" data-orig-size=\"1612,398\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.38.57\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-38-57.png?w=825\" \/><img decoding=\"async\" class=\"alignnone size-full wp-image-5604\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=825\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=825 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=150 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=300 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=768 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=1024 1024w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png 1052w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.53.18\" data-attachment-id=\"5604\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-15-53-18\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png\" data-orig-size=\"1052,368\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 15.53.18\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-15-53-18.png?w=825\" \/><\/a><\/p>\n<h1><strong>(2)\u00a0Den perifere smerte\u00a0proces: nociception<\/strong><\/h1>\n<div class=\"page\" title=\"Page 2\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<div class=\"page\" title=\"Page 2\">\n<div class=\"layoutArea\">\n<p>En v\u00e6vsskade involvere en proces af forskellige inflammationsmark\u00f8rer der bliver frigivet ved en skade. Disse mark\u00f8rer er blandt andet bradykinin, histamine, 5-hydroxytryptamine, ATP, nitric oxide og visse\u00a0ioner (K+\/H+). Derudover vil arachidonics acid (v\u00e6ske) f\u00f8rer til at kemiske signalstoffer s\u00e5som prostaglandiner, thromboxaner og leukotriene produceres og aktiveres. Ogs\u00e5 andre signalstoffer s\u00e5som cytokiner\u00a0bliver frigivet \u00a0ved akut inflammation. Cytokines \u00f8ger produktion af v\u00e6kstfaktorer (nerve growth factor (NGF) og dette har betydning for frigivelse af histamine og serotonin. Dette giver igen \u00f8get sensitivering til nociception og\u00a0evt. \u00e6ndre egenskaberne for A\u03b4 fibre, s\u00e5ledes at en st\u00f8rre andel bliver nociceptive.\u00a0Andre stoffer\u00a0s\u00e5som aminosyrer (glutamat) og opioider (endothelin-1) er ogs\u00e5 tilstede i den akutte inflammation. Nogle af alle disse mark\u00f8rer kan direkte aktivere nociception, mens andre mark\u00f8rer faciliteter andre celler til at udl\u00f8se nociception.<\/p>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-5605\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=825\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=825 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=1650 1650w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=150 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=300 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=768 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=1024 1024w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 16.12.09\" data-attachment-id=\"5605\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-16-12-09\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png\" data-orig-size=\"1658,912\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 16.12.09\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-12-09.png?w=825\" \/><\/p>\n<div class=\"page\" title=\"Page 2\">\n<div class=\"layoutArea\">\n<p>Denne proces resulterer i en lavere t\u00e6rskelv\u00e6rdi for nociception \/ hurtigere fyringsevne bliver hurtigere en dens\u00a0normale input og \/ output. Det er det vi kalder perifer sensibilisering.<\/p>\n<p>Mens nogle af disse kemiske mark\u00f8rer aktiverer nociception direkte, leder\u00a0andre til \u00e6ndringer i den sensoriske neuron fremfor direkte at aktivere den. Disse \u00e6ndringer kan f\u00f8rer til fx. \u00e6ndringer i ion-kanalerne.<a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png\"><img decoding=\"async\" class=\"alignnone wp-image-5637 size-full\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=825\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=825 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=1650 1650w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=150 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=300 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=768 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=1024 1024w\" alt=\"Sk\u00e6rmbillede 2015-08-17 kl. 19.48.29\" data-attachment-id=\"5637\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-17-kl-19-48-29\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png\" data-orig-size=\"1856,1012\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-17 kl. 19.48.29\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-17-kl-19-48-29.png?w=825\" \/><\/a><\/p>\n<h1><a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png\"><img decoding=\"async\" class=\"alignnone size-full wp-image-5606\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=825\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=825 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=1650 1650w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=150 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=300 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=768 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=1024 1024w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 16.30.07\" data-attachment-id=\"5606\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-16-30-07\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png\" data-orig-size=\"1660,924\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 16.30.07\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-16-30-07.png?w=825\" \/><\/a><strong>(3) Spinal Cord \/ Central sensitisation<\/strong><\/h1>\n<p class=\"page\" title=\"Page 2\">Central sensibilisering bruges til at beskrive det f\u00e6nomen hvorved den centrale smertesignalering bliver overf\u00f8lsomme over for input fra disse receptorer.<\/p>\n<p class=\"page\" title=\"Page 2\">N\u00e5r\u00a0kroppen modtager sit input fra et skadet omr\u00e5de, gennem de afferent signaler til det dorsale horn i <img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5623 alignright\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png?w=379&amp;h=255\" sizes=\"(max-width: 379px) 100vw, 379px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png?w=379&amp;h=255 379w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png?w=758&amp;h=510 758w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png?w=150&amp;h=101 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png?w=300&amp;h=202 300w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 19.11.17\" width=\"379\" height=\"255\" data-attachment-id=\"5623\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-19-11-17\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png\" data-orig-size=\"1054,710\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 19.11.17\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-17.png?w=825\" \/>rygmarven, herunder dem fra nociceptorer og mekanoreceptorer, vil signal afh\u00e6ngig af t\u00e6rskelv\u00e6rdien skifte niveau via en synapse fra det perifere sensoriske system til rygmarven og videre op til fortolkning i hjernen. Den transport af interneuroner kan enten inhiberes (analgesi) eller forst\u00e6rkes (allodynia) signalet gennem forskellige kemiske processer som kan indtages som medicin.<\/p>\n<p class=\"page\" title=\"Page 2\">Ved hurtige pludselige synapser \/\u00a0signal\u00e6ndringer omtales \u00a0det som\u00a0\u2018\u201dWind-up effekten\u201d hvor stimuliet blusser op. Ved l\u00e6ngerevarende \u00e6ndringer, via \u00f8get t\u00e6rskelv\u00e6rdi, vil\u00a0 \u00e6ndringer i ion-cellerne kan det skabe en \u00f8get central sensibiliteringen.<\/p>\n<p class=\"page\" title=\"Page 2\"><a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-5609\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=640&amp;h=317\" sizes=\"(max-width: 640px) 100vw, 640px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=640&amp;h=317 640w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=1280&amp;h=634 1280w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=150&amp;h=74 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=300&amp;h=148 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=768&amp;h=380 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=1024&amp;h=506 1024w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 18.05.02\" width=\"640\" height=\"317\" data-attachment-id=\"5609\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-18-05-02\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png\" data-orig-size=\"1666,824\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 18.05.02\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-05-02.png?w=825\" \/><br \/>\n<\/a><strong>Key words<\/strong><\/p>\n<ul>\n<li class=\"page\" title=\"Page 2\">N\u00e5r man udvikler smerte, \u00f8ges smertesensibiliering til form\u00e5l for at beskytte dig ikke \u00f8del\u00e6gge dig.<\/li>\n<li class=\"page\" title=\"Page 2\"><img decoding=\"async\" class=\"alignnone size-full wp-image-5624\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=825\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=825 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=150 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=300 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=768 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=1024 1024w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png 1100w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 19.11.10\" data-attachment-id=\"5624\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-19-11-10\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png\" data-orig-size=\"1100,336\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 19.11.10\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-11-10.png?w=825\" \/><\/li>\n<\/ul>\n<h1 class=\"page\" title=\"Page 2\"><strong>(4) hjernen<\/strong><\/h1>\n<p class=\"page\" title=\"Page 2\">N\u00e5r vi m\u00e6rker et nociceptiv stimuli kan\u00a0informationen fra rygmarven til hjernen (thalamus) ske via flere forskellige veje. Thalamus modtager sensorisk information og sender det til hjernebarken, som derefter sender disse oplysninger videre til andre dele af hjernen s\u00e5som det<a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensory_cortex\">\u00a0somatosensory cortex<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insular_cortex\">the anterior insular cortex<\/a> (hvor f\u00f8lelser registreres)\u00a0og det <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cingulate_cortex\">cingulate cortex<\/a> (styre det limbiske system, l\u00e6ring og hukommelse). Smerte er yderst kompleks og involvere og andre dele af hjernen s\u00e5som<a href=\"https:\/\/da.wikipedia.org\/wiki\/Amygdala\">\u00a0amygdala<\/a> (h\u00e5ndterer frygt og forsvarsreaktioner), <a href=\"https:\/\/da.wikipedia.org\/wiki\/Pr%C3%A6frontal_cortex\">prefrontal cortex<\/a>, <a href=\"https:\/\/da.wikipedia.org\/wiki\/Lillehjerne\">cerebellum<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Basal_ganglia\">basal ganglia.<\/a><\/p>\n<p class=\"page\" title=\"Page 2\">En af vejene v\u00e6re v\u00e6re den direkte vej fra rygmarvenen til thalamus og kaldes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinothalamic_tract\">spinothalamus.<\/a><img decoding=\"async\" class=\"alignnone wp-image-5622 size-large\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png?w=825&amp;h=537\" sizes=\"(max-width: 825px) 100vw, 825px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png?w=825&amp;h=537 825w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png?w=150&amp;h=98 150w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png?w=300&amp;h=195 300w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png?w=768&amp;h=499 768w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png 972w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 19.12.14\" data-attachment-id=\"5622\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-19-12-14\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png\" data-orig-size=\"972,632\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 19.12.14\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png?w=300\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png?w=825\" \/><\/p>\n<h1 class=\"page\" title=\"Page 2\"><a href=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png\"><img decoding=\"async\" class=\"alignnone size-full wp-image-5610\" src=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png?w=825\" sizes=\"(max-width: 784px) 100vw, 784px\" srcset=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png 784w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png?w=105 105w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png?w=211 211w, https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png?w=768 768w\" alt=\"Sk\u00e6rmbillede 2015-08-15 kl. 18.15.52\" data-attachment-id=\"5610\" data-permalink=\"https:\/\/physioblogandreasbjerregaard.com\/2015\/08\/15\/mekanoreceptorer-og-nociceptorer\/skaermbillede-2015-08-15-kl-18-15-52\/\" data-orig-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png\" data-orig-size=\"784,1116\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Sk\u00e6rmbillede 2015-08-15 kl. 18.15.52\" data-image-description=\"\" data-medium-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png?w=211\" data-large-file=\"https:\/\/andreasbjerregaard.files.wordpress.com\/2015\/08\/skc3a6rmbillede-2015-08-15-kl-18-15-52.png?w=719\" \/><\/a><strong>(5) Overvejelser i diagnosticering<\/strong><\/h1>\n<p>I vores normale unders\u00f8gelse starter vi ud men at f\u00e5 en historik omkring skadens omfang. Og her er det vigtigt at opfange forskellige bidragsyder der kan skabe \u00f8get central sensibilisering.<\/p>\n<p>Det\u00a0er vanskeligt at skelne mellem hvad der forudsager smerten. Men viden om neuronale plasticitet og kemiske inflammatoriske processer kan vigtigere end tidligere antaget. Det inkludere viden en r\u00e6kke\u00a0faktorer, herunder patientens forventninger, f\u00f8lelser og angst for yderligere skade (fear avoidence) osv. Derfor er patientuddannelse (viden omkring smerteprocesser (ikke anatomiske modeller), almen motion, medicin, kost, s\u00f8vn og \u00e5ndedr\u00e6t) liges\u00e5 vigtig for smertereduktion som andre smerte modulatorer s\u00e5som paracetamol, injektion, blokader, akupunktur, fysioterapeutisk tr\u00e6ningsinterventioner og kirurgi.<br \/>\nNedenst\u00e5ende link henviser til en casehistorie fra moseley ved brug af smerteundervisning og hvilke processer der sker i hjernen.<\/p>\n<p>Opsummering p\u00e5 studie fra\u00a0<strong><em>G., L., Moseley, 2005<br \/>\n<\/em><\/strong><\/p>\n<p class=\"entry-title\"><a href=\"https:\/\/andreasbjerregaard.wordpress.com\/2014\/12\/06\/praesentation-af-et-case-studie-af-lorimor-moseley-2005-smerte-pain\/\">Pr\u00e6sentation af et Case-studie af Lorimor Moseley, 2005 #smerte\u00a0#pain<\/a><strong><em><br \/>\n<\/em><\/strong><br \/>\n<strong><em><a href=\"http:\/\/ajp.physiotherapy.asn.au\/AJP\/51-1\/AustJPhysiotherv51i1Moseley.pdf\">Widespread brain activity during an abdominal task<\/a><\/em><br \/>\n<em><a href=\"http:\/\/ajp.physiotherapy.asn.au\/AJP\/51-1\/AustJPhysiotherv51i1Moseley.pdf\">markedly reduced after pain physiology education: fMRI<\/a>\u00a0<\/em><em><a href=\"http:\/\/ajp.physiotherapy.asn.au\/AJP\/51-1\/AustJPhysiotherv51i1Moseley.pdf\">evaluation of a single patient with chronic low back pain<\/a>.<\/em><\/strong><\/p>\n<\/div>\n<p>Derudover vil jeg anbefale at l\u00e6se p\u00e5<\/p>\n<\/div>\n<p>Lars Avemarie\u00a0<a href=\"http:\/\/www.smertespecialisterne.dk\/\">www.Smertespecialisterne.dk<\/a><\/p>\n<p>Simon Kirkegaard:\u00a0<a href=\"http:\/\/www.smertevidenskab.dk\/\">www.smertevidenskab.dk<br \/>\n<\/a><\/p>\n<p>Morten H\u00f8gh:\u00a0<a href=\"http:\/\/www.videnomsmerter.dk\/\">www.videnomsmerter.dk<\/a><\/p>\n<p>Greg Lehman:<a href=\"http:\/\/www.physiofundamentals.com\/\">\u00a0www.physiofundamentals.com<\/a><\/p>\n<p>Lorimer Moseley: <a href=\"http:\/\/www.bodyinmind.org\/\">www.BodyinMind.org<\/a><\/p>\n<p>NOI group:\u00a0<a href=\"http:\/\/www.noigroup.com\/en\/Home\">www.noigroup.com<\/a><\/p>\n<div class=\"page\" title=\"Page 2\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"jp-post-flair\" class=\"sharedaddy sd-like-enabled sd-sharing-enabled\">\n<div class=\"sharedaddy sd-sharing-enabled\"><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Indl\u00e6g om kemisk smerteforst\u00e5else; Central sensibilitering, mekanoreceptorer og nociceptorer. Dette blogindl\u00e6g bygger p\u00e5 artiklen\u00a0Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain (2013), Dean, J. L\u00e6s her:Dean 2013 why does my shoulder hurt: Skrev for at f\u00e5 stuidet eller request for the study on <a href=\"http:\/\/www.reseachgate.com\" rel=\"nofollow\">http:\/\/www.reseachgate.com<\/a> N\u00e5r vi taler [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1649,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","om_disable_all_campaigns":false,"_surecart_dashboard_logo_width":"180px","_surecart_dashboard_show_logo":true,"_surecart_dashboard_navigation_orders":true,"_surecart_dashboard_navigation_invoices":true,"_surecart_dashboard_navigation_subscriptions":true,"_surecart_dashboard_navigation_downloads":true,"_surecart_dashboard_navigation_billing":true,"_surecart_dashboard_navigation_account":true,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[10,173],"tags":[194,45],"class_list":["post-1648","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-pain","category-physiology","tag-lowbackpain","tag-pain"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"aioseo_notices":[],"jetpack_featured_media_url":"https:\/\/andreasphysioblog.com\/wp-content\/uploads\/2021\/05\/skc3a6rmbillede-2015-08-15-kl-19-12-14.png","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=\/wp\/v2\/posts\/1648","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1648"}],"version-history":[{"count":1,"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=\/wp\/v2\/posts\/1648\/revisions"}],"predecessor-version":[{"id":1650,"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=\/wp\/v2\/posts\/1648\/revisions\/1650"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=\/wp\/v2\/media\/1649"}],"wp:attachment":[{"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1648"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1648"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/andreasphysioblog.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1648"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}