Health & Medical Rheumatoid Arthritis

Sympathetic Nervous System Dysfunction in Multiple Illnesses

´╗┐Sympathetic Nervous System Dysfunction in Multiple Illnesses

Abstract and Introduction

Abstract


Background: Fibromyalgia often coexists and overlaps with other syndromes such as chronic fatigue, irritable bowel syndrome, and interstitial cystitis. Chronic stress has been implicated in the pathogenesis of these illnesses. The sympathetic nervous system is a key element of the stress response system. Sympathetic dysfunction has been reported in these syndromes, raising the possibility that such dysautonomia could be their common clustering underlying pathogenesis.

Objective: The objective of this study was to carry out a review of all published comparative case-control studies investigating sympathetic nervous system performance in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis.

Methods: Online databases PubMed and EMBASE were accessed using the following key words: autonomic (OR) sympathetic (AND) fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. All entries up to December 10th 2012 were reviewed by 2 independent investigators searching for case-control studies in humans. The Method for Evaluating Research and Guidelines Evidence adapted to the Scottish Intercollegiate Guidelines Network was used to rank the level of evidence contained in the selected articles.

Results: A total of 196 articles are included in this review. The most often used methods to assess sympathetic functionality were heart rate variability analysis, sympathetic skin response, tilt table testing, and genetic studies. The majority of studies (65%) described sympathetic nervous system predominance in these overlapping syndromes. In contrast, 7% of the studies found parasympathetic predominance.

Conclusions: This review demonstrates that sympathetic nervous system predominance is common in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. This concordance raises the possibility that sympathetic dysfunction could be their common underlying pathogenesis that brings on overlapping clinical features. The recognition of sympathetic predominance in these 4 syndromes may have potential clinical implications. It may be worth exploring the use of nonpharmacological measures as well as drug therapies aimed to regain autonomic balance.

Introduction


Fibromyalgia often coexists and overlaps with other controversial syndromes such as chronic fatigue, irritable bowel syndrome, and interstitial cystitis. These syndromes are very frequent in different clinical settings. The pathogenesis of these illnesses has not been elucidated. Chronic stress has been implicated in the development of fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. An acceptable physiological definition of stress could be "any stimuli, physical, or emotional that threatens homeostasis."

The sympathetic nervous system is a key element of the stress response system. Sympathetic dysfunction has been reported in the 4 syndromes under discussion, raising the possibility that such dysautonomia could be their common clustering underlying pathogenesis.



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