[Physical therapy with analgesic effects in inflammatory rheumatic diseases]

In praxis, one is not only concerned about the linear connection between rheumatic inflammation and pain therapy--pharmacological or physical treatment--but about an optimal connection of the whole spectrum of symptoms regarding the joint status with different options of actions on one hand, and the treatment procedure of choice beside pain therapy on the other hand. The understanding of the mode of action regarding physiotherapeutic methods with analgetic effects is due to the knowledge about the pathophysiologic relationship between inflammation and pain. On one hand, the information of pain from the periphery causes a sensibilisation of central nervous areas and therefore allodynia as well as irradiation of the painful area. On the other hand, biochemical processes lead to a neurogenic and alogenic inflammation due to the impact on the pain nerves. Beside the arthritis itself, the physiotherapy of a rheumatic-inflamed painful joint has to take into account the components arthralgia, irritation of the capsula, periarthropathia, and allogenic inflammation. Physiotherapeutic pain treatment has three modes of action: a causal effect on the structural level, suppression of over-excitation of the tissue as well as the central nervous transmission areas, and activation of the decelerating pain modulating systems. Each treatment procedure with analgetic effects like cooling, heating, localized mechanical methods, the activation techniques with proprio- and exteroceptive effects (TENS, Maitland-mobilisation), the electrotherapeutic option, and physical training therapy is characterized with its specific mode of action. The dosage of physiotherapeutic techniques has to be taken into account since it has to remain within physiologic limits and the tissue's irritability must not be reached.