Autonomic Disfunction (Dysautonomia)

Overview

Autonomic Dysfunction, often referred to as dysautonomia, encompasses a group of disorders affecting the Autonomic Nervous System (ANS). The ANS is responsible for regulating vital involuntary bodily functions, such as heart rate, blood pressure, breathing, digestion, body temperature, sweating, and pupil response.

When the ANS does not function correctly, individuals can experience a wide range of debilitating symptoms impacting multiple body systems.

Dysautonomia can be primary (occurring on its own) or secondary (resulting from another underlying condition, such as diabetes, Parkinson's disease, autoimmune disorders, or certain infections). While some forms can be challenging to manage, understanding the condition is key, and various treatments aim to control symptoms, improve daily functioning, and enhance the quality of life for those affected.

Symptoms

Because the ANS controls so many different bodily functions, symptoms of dysautonomia are diverse and can vary significantly between individuals and even day-to-day. Common symptoms often relate to the specific parts of the ANS affected and may include:

1. Cardiovascular Symptoms:

Dizziness, lightheadedness, or feeling faint (presyncope), especially upon standing up quickly.
Fainting or loss of consciousness (syncope).
Rapid heart rate (tachycardia) or unusually slow heart rate (bradycardia).
Palpitations (feeling the heart beat strongly or irregularly).
Significant fluctuations in blood pressure (high or low).
Chest pain or discomfort (non-cardiac origin typically).

2. Thermoregulatory Symptoms:

Abnormal sweating patterns (excessive sweating or inability to sweat).
Difficulty regulating body temperature, leading to heat or cold intolerance.
Skin changes, such as flushing or mottling.

3. Gastrointestinal Symptoms:

Nausea and/or vomiting.
Bloating, abdominal pain, or cramping.
Constipation or diarrhoea.
Difficulty swallowing (dysphagia) or feeling full quickly.

4. Other Common Symptoms:

Fatigue and exercise intolerance.
Shortness of breath.
Blurred vision or difficulty focusing pupils.
Bladder problems (incontinence or difficulty emptying).
Headaches or migraines.
Sleep disturbances.
Cognitive difficulties ("brain fog").

The severity and combination of symptoms depend on the specific type and cause of the dysautonomia.

Diagnoses

Diagnosing autonomic dysfunction can be complex due to the wide range of symptoms that often overlap with other conditions. A diagnosis typically involves:

Detailed Medical History: Understanding the specific symptoms, their triggers, timing, and impact on daily life.
Physical Examination: Including measurement of blood pressure and heart rate while lying down, sitting, and standing (orthostatic vital signs).
Specialized Autonomic Function Testing: These tests assess how the ANS is responding under specific conditions. Common tests include:
- Tilt Table Test: Monitors heart rate and blood pressure as the patient is tilted upright to evaluate for orthostatic intolerance.
- Quantitative Sudomotor Axon Reflex Test (QSART): Measures sweat gland function in response to stimulation.
- Thermoregulatory Sweat Test: Assesses the body's overall sweating pattern in a controlled temperature environment.
- Heart Rate Variability (HRV) Analysis: Measures variations in the time interval between heartbeats during rest and specific manoeuvres (like deep breathing).
- Blood Tests: To rule out or identify underlying conditions contributing to dysautonomia.

A diagnosis often requires careful evaluation by specialists familiar with autonomic disorders, such as neurologists or cardiologists.

Treatment

Treatment for autonomic dysfunction focuses primarily on managing symptoms, addressing any underlying causes if possible, and improving the patient's overall quality of life. Treatment plans are highly individualized. Common approaches include:

Lifestyle Modifications: These are often the first line of treatment and may include increasing fluid and salt intake (under medical guidance), wearing compression garments, raising the head of the bed, eating smaller, more frequent meals, and avoiding known triggers (like heat or prolonged standing).
Medications: Various medications may be prescribed to target specific symptoms, such as drugs to raise low blood pressure (e.g., midodrine, fludrocortisone), regulate heart rate (e.g., beta-blockers), manage nausea or constipation, or control bladder function.
Physical Therapy: Specific exercises can sometimes help improve tolerance to positional changes and manage fatigue.
Innovative Interventions: For certain types of autonomic dysfunction, particularly those involving an overactive sympathetic nervous system ("fight-or-flight" response), interventions like the Stellate Ganglion Block (SGB), also known as the Dual Sympathetic Reset (DSR), may be considered.
- What it is: SGB involves injecting a local anaesthetic near the stellate ganglion, a nerve bundle in the neck associated with the sympathetic nervous system.
- Proposed Mechanism: The goal is to temporarily block or "reset" overactive sympathetic nerve signals, potentially alleviating symptoms related to this overactivity. It is thought to calm the body's stress response system.
- Procedure: It is a minimally invasive procedure performed by specialists.

In conjunction with the Stella Centre (Australia), Dr Paul Verrills at MetroPain is one of the leading experts in administering the Stellate Ganglion Blocks (SGB) treatments to sufferers of autonomic dysfunction, as well as complex pain and PTSD.

Managing autonomic dysfunction often requires a multidisciplinary approach and ongoing adjustments to the treatment plan.

If you feel you may be suffering from Autonomic Dysfunction, please reach out and we can assist with both referral and assessment for potential treatment of your condition.

Disclaimer
Please note the contents contained in this Patient Fact Sheet are not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Our specialists assess every patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative, and evidence-based treatments tailored to suit each patient. As such, recommended treatments and their outcomes will vary from patient to patient. If you would like to find out whether our treatments are suitable for your specific condition, please speak to your doctor at the time of your consultation.