Viscerosomatic reflex

Block of the sympathetic nerves to thoracic or abdominal viscera is useful in reheving severe visceral pain that is not amenable to other therapies, or it can be an important adjunct. This is based on the fact that afferent nerves that convey nociceptive impulses from the viscera accompany the efferent sympathetic nerves. Block with ethanol or phenol not only relieves pain, but also interrupts the afferent and efferent Hmbs of abnormal viscerovisceral and viscerosomatic reflexes that often develop and contribute to the pathophysiology (Bonica 1990b O Neil and Burchiel 1991). 

Acute viscerosomatic reflex dysfunctions are probably indistinguishable from any other acute somatic dysfunction. Chronic viscerosomatic dysfunctions have a few characteristics that may aid in differentiating them from somatic dysfunctions of other causes. 

It is important to know the location of sympathetic innervation in relation to the thoracic and upper lumbar vertebrae so that viscerosomatic reflex dysfunctions may be used for diagnostic purposes. The patterns appear to follow these autonomic nerve distributions. 

Somatovisceral reflexes produce unmeasured changes on the internal organs. Sympathetic stimulation may promote or maintain a disease process. Relief of this source, if performed early enough, should alleviate the symptoms and the disease process. The viscerosomatic reflex is less amenable to cure. Manipulating the affected soma should have a beneficial effect in reducing symptoms, but the overall effect on the visceral component is indeterminable at this time. If we postulate a "tape loop" that promotes the whole process, then anything that breaks the cycle is of importance. 

Posteriorly, Chapman s reflexes are located in the soft tissues between the spinous process of a vertebra above and the transverse process of a vertebra below. For example, the posterior Chapman s point for the heart is located between the spinous and transverse process of the second and third thoracic vertebrae. The posterior points have the feel of a classic viscerosomatic reflex the operator will palpate what feels like a rubbery nodule. If the physician attempts to articulate a vertebral somatic dysfunction and the spine "bounces" away from the force, the possibility of a viscerosomatic reflex should be considered. 

Beal MC. Viscerosomatic reflexes A review./Am Osteo Assoc 1985. 

The associated musculoskeletal stmctures are evaluated for evidence of dysfunctions. Viscerosomatic reflex findings and Chapman s points may be useful in diagnosis. Viscerovisceral reflexes, somatovisceral reflexes, and abnormal sympathetic or parasympathetic influences all affect viscera. 

Between acute attacks, it is important to treat all components of the respiratory system. In particular, all viscerosomatic reflex areas should be treated to prevent possible abnormal autonomic feedback to the lungs. Freeing the occipitoatlan-tal joint may treat possible increased vagal involvement. 

An important part of the physical examination for the osteopathic physician is the structural examination. This not only provides information regarding the patient s neuromusculoskeletal system but also provides clues to visceral problems as well through viscerosomatic reflex findings and Chapman s reflex points. 

Viscerosomatic reflexes from the heart and lungs will be treated as a combination of the two models of respiratory/circulatory and neurological when this is determined to be useful. 

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