• The Korean Journal of Pain
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• 제35권3호
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• pp.327-335
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• 2022

Background: The pathophysiology of fibromyalgia (FM) involves many mechanisms including central nervous system sensitization theory, autonomic nervous system (ANS) dysfunction, and recently small fiber neuropathy. While the small fiber neuropathy itself can cause ANS dysfunction and neuropathic pain (NP), it is still unknown whether ANS problems have an association with severity of disease and NP in patients with FM. The aim of this study was to evaluate ANS dysfunction in FM patients and to explore possible associations of ANS dysfunction with disease severity and NP. Methods: Twenty-nine FM patients and 20 healthy controls were included in this cross-sectional study. Participants were tested using sympathetic skin responses (SSR) and R-R interval variation analyses for sympathetic and parasympathetic ANS dysfunction, respectively. Disease severity and somatic symptoms of patients with FM were evaluated using the ACR-2010 scales and Fibromyalgia Impact Questionnaire, and NP symptoms were evaluated using the Pain Detect Questionnaire and Douleur Neuropathique questionnaire. Results: FM patients were found to have ANS dysfunction characterized by increased sympathetic response and decreased parasympathetic response. SSR amplitudes were found to be correlated with a more severe disease. Although nonsignificant, NP severity tended to be associated with a decrease in sympathetic and parasympathetic activities. Conclusions: ANS dysfunction may play a role in the pathophysiology of FM. The trend of decreased ANS functions in FM patients exhibiting NP contradicts the notion that FM is a sympathetically maintained NP and may be explained with small fiber involvement.

• 대한핵의학회지
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• 제38권5호
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• pp.331-337
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• 2004

Cardiac neurotransmission imaging allows in vivo assessment of presynaptic reuptake, neurotransmitter storage and postsynaptic receptors. Among the various neurotransmitter, I-123 MIBG is most available and relatively well-established. Metaiodobenzylguanidine (MIBG) is an analogue of the false neurotransmitter guanethidine. It is taken up to adrenergic neurons by uptake-1 mechanism as same as norepinephrine. As tagged with I-123, it can be used to image sympathetic function in various organs including heart with planar or SPECT techniques. I-123 MIBG imaging has a unique advantage to evaluate myocardial neuronal activity in which the heart has no significant structural abnormality or even no functional derangement measured with other conventional examination. In patients with cardiomyopathy and heart failure, this imaging has most sensitive technique to predict prognosis and treatment response of betablocker or ACE inhibitor. In diabetic patients, it allow very early detection of autonomic neuropathy. In patients with dangerous arrhythmia such as ventricular tachycardia or fibrillation, MIBG imaging may be only an abnormal result among various exams. In patients with ischemic heart disease, sympathetic derangement may be used as the method of risk stratification. In heart transplanted patients, sympathetic reinnervation is well evaluated. Adriamycin-induced cardiotoxicity is detected earlier than ventricular dysfunction with sympathetic dysfunction. Neurodegenerative disorder such as Parkinson's disease or dementia with Lewy bodies has also cardiac sympathetic dysfunction. Noninvasive assessment of cardiac sympathetic nerve activity with I-123 MIBG imaging nay be improve understanding of the pathophysiology of cardiac disease and make a contribution to predict survival and therapy efficacy.

• 한방안이비인후피부과학회지
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• 제22권1호
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• pp.133-140
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• 2009

Objective : To evaluate autonomic nerve balance and sympathetic nerve activity in patients with inner ear dysfunction as examined by heart rate variability(HRV) Research Methods and Procedures : One hundred and twenty three patients(between 15 to 59 years old) who visited Dept. of Oriental medical Opthalmology & Otolaryngology, Kyunghee university and had an examination of HRV test, were selected as subjects of our study. We checked items of HRV test(such as SDNN, RMSSD, LF, HF, TP, norm-LF, norm-HF, LF/HF ratio), and analyzed time and frequency domain differences between three groups classified as tinnitus, hearing loss and vertigo. And we compared HRV items(such as SDNN,RMSSD, TP and LF/HF ratio) with standard levels. Results and Conclusion : Our results showed no significant differences between three groups in HRV items except for mean heart rate. Patients with inner ear dysfunction showed significant lower TP than 2000$(ms^{2})$(p <0.001) and significant higher LF/HF ratio than 1.5(p=0.003). So we suggest that patients with inner ear dysfunctions such as tinnitus, vertigo and hearing loss, have sympathetic hypertonus and inactivity of autonomic nerve regulation.

• Korean Journal of Acupuncture
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• 제33권3호
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• pp.95-101
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• 2016

Objectives : This study aims to overview the therapeutic mechanism of back-shu points in terms of sympathetic visceral motor nervous system. Methods : Studies about autonomic nervous system, and studies and ancient texts about back-shu points were reviewed. We interpreted possible mechanism of back-shu points considering similarities of anatomical and physiological characteristics of back-shu points and visceral motor nervous system. Results : Afferent signals for organ lesions that can develop the symptoms of autonomic neurological symptoms, pain, hyperalgesia through the skin segment. Through a physical examination of the myotome and dermatome, it is possible to diagnose segmental disorders. Treatment stimulation of the thick fibers of the disorder segment skin can reduce abnormal autonomic influence over the sympathetic reflex mechanism. In addition, if spinal muscles are relaxed, the pressure on the nerve roots could be reduced and consequently the hyperactivity of the sympathetic visceral motor signal would be suppressed. Conclusions : The back-shu points treatments work through the mechanism of the sympathetic nervous reflex. Moreover, segmental acupuncture can reduce tension of the spinal muscles, thereby improving pathological conditions of the sympathetic nervous system.

• Tuberculosis and Respiratory Diseases
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• 제46권3호
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• pp.317-326
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• 1999

연구목적: 호흡기에 대한 자율신경 기능도 기도 및 혈관의 평활근, 접막하선의 점액분비. 기관지 순환 혈류조절, 비만 세포의 염증 반응에 관계되는 매개물의 분비등 매우 다양하게 나타나며 이들 자율신경 장애는 기도 폐쇄의 원인으로 작용한다. 천식은 자율신경계 이상이 원인으로 작용하고 특히 부교감신경 기능 항진이 중요한 원인으로 알려져 있다. 저자들은 심혈관계와 호흡기 자율신경 지배가 공통적으로 일어난다는 사실을 기초로 비관혈적이고 안정한 심혈관 지율신경 검사를 실시하여 만성 폐쇄성 폐질환 환자에서 자율신경 장애유무를 알아보았다. 방 법: 대상은 영남대학교 의과대학 부속병원에서 만성 폐쇄성 폐질환으로 진단 받은 환자 20명과 건강진단 센터에서 건강한 것으로 판정 받은 비슷한 나이의 20명을 대조군으로 하였다. 만성 폐쇄성 폐질환은 American Thoracic Society의 정의를 따랐으며 허혈성 심장질환, 부정맥, 당뇨병, 중심성 및 말초성 신경질환 등과 같은 자율신경계에 영향을 미칠 수 있는 질환이 동반된 경우는 제외하였다. 자율신경검사는 Ewing과 Clarke의 방법을 사용하였으며 모든 대상에서 동맥혈 가스분석과 폐기능 검사를 동시에 실시하였다. 결 과: 만성 폐쇄생 폐질환 환자는 건강한 사랑에 비하여 빈번하게 자율신경 장애가 동반되어 있었으며 만성 폐쇄성 폐질환 환자에서 교감신경 장애보다 부교감신경 장애가 더 뚜렷하였다. 만성 폐쇄성 폐질환은 질병 이환 기간이 길거나, 흡연량이 많거나, 폐기능 검사상 $FEV_1$ 및 FVC 감소 정도가 심할수록 그리고 저산소혈증이 심한 경우에 자율신경 장애가 심하였으나 연령, 만성폐쇄성 폐질환의 종류 및 동맥혈 이산화탄소 분압과는 차이가 없었다. 결 론: 만성 폐쇄성 폐질환은 부교감신경 장애가 동반되어 있으며, 부교간신경 장애는 만성 폐쇄성 폐질환의 정도가 심할수록 더 뚜렷하게 나타났다. 이러한 부교감신경 장애는 만성 폐쇄성 폐질환의 원인으로 작용하기보다는 질병의 진행으로 인한 자율신경계의 기능 저하로 생각된다.

• Korean Journal of Acupuncture
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• 제24권4호
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• pp.25-36
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• 2007

Objectives : Acupuncture restores the flow of vital energy in the body by stimulating the organ-specific meridians and enhances cardiac vagal activity and suppresses sympathetic activity. The purpose of this review is to summarize and evaluate the acupuncture studies on autonomic nervous system (ANS). Methods : We conducted a PubMed search to obtain a fair sample of acupuncture studies related ANS published in English in 2007. Each article was reviewed for study objectives and outcomes, as well as acupuncture points, experimental and control interventions. Results : We reviewed a total of 15 studies published from 1997 to 2007. In normal states, acupuncture enhanced either vagal or sympathetic tone depending on the stimulated acupuncture point sites. On the other hand, most of studies demonstrated that acupuncture restored the autonomic dysfunctions in various kinds of stressful states. Conclusions : We reviewed studies that contributed to an understanding of the autonomic mechanisms of acupuncture with the hope that this review will be of benefit to the future studies. Although the relationship between acupuncture and ANS response is still uncertain, acupuncture would be a noteworthy modality for modulating autonomic dysfunction.

• 대한한의진단학회지
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• 제15권2호
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• pp.127-140
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• 2011

Objectives: Acupuncture has been shown to relieve pain and modulate biological function by stimulating the organ-specific meridians and enhances parasympathetic activity and suppresses sympathetic activity. The aim of this review is to summarize and understand the effects of acupuncture on autonomic nervous system. Methods: We reviewed a total of 29 studies published from 2000 to 2010 searched by PueMed and various domestic oriental medicine journals to obtain acupuncture studies related with ANS. Each article was classified by ANS measurement index and reviewed for study objectives, outcomes, acupuncture points, experimental and control interventions. Results: In the study of acupuncture about EEG, HRV, SCR, the experiment results are not the same by acupoints. Although same acupoint the results differ by subject's condition. But the study showed some clear tendency. In brief, in normal states acupuncture enhanced either vagal or sympathetic tone depending on the stimulated acupuncture point sites. On the other hand, most of studies demonstrated that acupuncture restored the autonomic dysfunctions in various kinds of tired or stressful states. Conclusions: We reviewed studies that contributed to an understanding of the effects and mechanisms of acupuncture on autonomic nervous system. Although the relationship between acupuncture and ANS response is still uncertain, acupuncture could be a excellent treatment method for modulating autonomic dysfunction.

• Annals of Clinical Neurophysiology
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• 제23권2호
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• pp.126-129
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• 2021

We present a patient with a primitive neuroectodermal tumor arising from the right atrium who experienced multiple syncope episodes daily, which had first appeared 1 month after surgery. The symptoms continued to worsen over the course of chemotherapy, and the autonomic function test (AFT) was performed after the 14th chemotherapy cycle. The AFT revealed orthostatic hypotension and reduced baroreflex-dependent sympathetic reactivity. Physical counterpressure techniques were applied with a visual biofeedback intervention, and were found to be effective in reducing the syncope episodes.

• Annals of Clinical Neurophysiology
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• 제25권1호
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• pp.32-37
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• 2023

Background: Type 2 diabetic mellitus (T2DM) is an emerging global pandemic which is associated with lots of co-morbidities and reported vascular dysfunctions. T2DM associated vascular dysfunctions leads to vasculopathy in the form of altered peripheral vascular dynamics. Cold stress test (CST) is a reliable sympathetic reactivity test used for assessing vascular dysfunctions. In this study we are trying to quantify vascular dysfunctions in T2DM patients non invasively by various parameters of photoplethysmography (PPG) of cold stress test. Methods: Case control study had done in referral health center AIIMS, Raipur. Parameters are recorded by finger-PPG before, during and after CST (1 min) in 2 groups, control (n = 20 healthy volunteers) and case (n = 20 diagnosed T2DM patients). Results: Due to cold stress, PPG parameter peak amplitude was significantly decreased in both healthy and T2DM groups (p <0.001 and p <0.001, respectively). However, recovery trend of amplitude was significantly slow in T2DM compared to healthy subjects. Another PPG parameter peak to peak interval was significantly higher in healthy group compared to T2DM patients. Conclusions: This study showed that T2DM patients has significant deranged pulse volume parameters like amplitude and peak to peak interval can be used to objectively quantify the vasculopathy in T2DM patients by using sympathetic reactivity to cold stress.

• Korean Journal of Acupuncture
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• 제19권2호
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• pp.97-117
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• 2002

Chiropractic is very similar to Oriental Medicine in philosophy on the cause of diseases and in utilization of spinal articulations for diagnosis and treatment. In this paper the spinal area used to treat liver dysfunction in S.O.T. technique, one of chiropractic techniques, was compared to the acupncture points used to cure the same conditions. Because both Oriental medicine and Chiropractic are dealing with autonomic nervous system in regulating abnormal conditions, also the innervation of spinal nerves to those areas was checked. The spinal area that S.O.T. technique utilizes to correct liver dysfunction is transverse processes of T8, which corresponds to B16. Acupncture points from this level down to T12/L1, which are B16, B17, B18, B19, B20, B21, B45, B46, B47, B48, B49, B50, GV6, GV7, GV8 and GV9, all have been applied to control liver function. Apparent discrepency exists in therapeutic areas for liver malfunction between the two natural healing arts. According to the neurology texts, liver is innervated by sympathetic fibers from the 7th-10th thoracic segments and by parasympathetic fibers from vagus nerve. Sympathetic afferent nerves from the liver reach the 7th-12th thoracic spinal cord segments. It can be said all the 7th-12th thoracic spinal cord segments are related to liver function. Therefore the areas used for liver dysfunction in both natural medicine are appropriately selected. However, B16, the Oriental medical equivalent of the main spinal area which is used for lowered liver function in C.M.R.T. Technique, is not utilized as frequent as in Oriental medicine.