From the Guidelines
Treatment for Autonomic Nervous System (ANS) dysfunction caused by chronic stress should focus on addressing the underlying stress and promoting resilience.
Key Components of Treatment
- Mindfulness-based therapies: such as brain–gut behaviour therapy (BGBT) [ 1 ], which aims to improve psychological and physiological resilience to stress
- Stress management techniques: to reduce the impact of chronic stress on the autonomic nervous system and the HPA axis
- Addressing comorbidities: such as depression, which often co-exists with ANS dysfunction and can exacerbate symptoms [ 1 ]
Rationale
The autonomic nervous system plays a crucial role in regulating various bodily functions, and chronic stress can lead to its dysregulation [ 1 ]. This dysregulation can impair gut function and contribute to the development of gastrointestinal symptoms. By addressing the underlying stress and promoting resilience, treatment can help to mitigate the effects of ANS dysfunction and improve overall well-being.
Supporting Evidence
Studies have shown that psychological and physiological resilience to stress are reduced in individuals with irritable bowel syndrome (IBS) and other disorders characterized by ANS dysfunction [ 1 ]. Brain–gut behaviour therapy (BGBT) has been identified as a novel therapeutic target for improving resilience and reducing symptoms in these individuals [ 1 ].
From the Research
Treatment for Autonomic Nervous System (ANS) Dysfunction
The treatment for Autonomic Nervous System (ANS) dysfunction caused by chronic stress is a complex process that requires a comprehensive approach. Some of the key aspects of treatment include:
- Management of orthostatic hypotension using mineralocorticoids, direct and indirect sympathomimetic agents, and other pressors 2
- Treatment of urinary incontinence and retention using drugs that modulate bladder contractility and bladder outlet resistance 2
- Therapies for bowel dysmotility syndromes, such as gastroparesis, diarrhea, and fecal incontinence, using bulk agents, laxatives, prokinetic agents, and antidiarrheal drugs 2
- Exercise training, which has been shown to have anti-inflammatory and antioxidant effects on the ANS 3
- Consideration of ANS dysfunction at each stage of the diagnostic and treatment processes, as a predictor for the patient's clinical condition 4
Diagnostic Considerations
Diagnosing ANS dysfunction requires precise diagnostics, frequently involving several specialists and a number of diagnostic tests 4. The symptoms of ANS dysfunction can be discrete and may develop earlier than symptoms specific to a given chronic disease, significantly influencing the treatment process itself 4.
Role of Exercise Training
Exercise training has been shown to have a positive impact on the ANS, with anti-inflammatory and antioxidant effects 3. However, the type, duration, and individual characteristics of the person doing the exercise can affect the outcome, and excessive exercise can induce oxidative stress 3.
Clinical Presentations
Clinical presentations of ANS dysfunction can overlap, and a thorough history is necessary for appropriate evaluation and treatment 5. Recognizing the presence of cardiac dysautonomia is an important skill for cardiologists and electrophysiologists, as it can affect the evaluation and management of patients with unexplained syncope, orthostatic intolerance, heart rhythm abnormalities, and symptoms of palpitations 5.