Vague and non-specific symptoms MUS

Vague and non-specific symptoms (Medically Unexplained Symptoms, MUS)

In most of the examinations carried out at General Medicine outpatient clinics, physicians focus their attention on overt clinical data, characterized by clearly recognizable symptoms. Other symptoms, which could be defined as vague, such as chronic fatigue, sleep or appetite disorders, irritable bowel or constipation, tone or mood disorders, non-specific pain syndromes etc., are sometimes underestimated. These signs remain largely unexplained, i.e. they are not traced back to a precise cause, disease or disorder. In Anglo-Saxon literature they are identified as “MUS”, Medically Unexplained Symptoms. The appearance of MUS in general medicine patients is becoming increasingly frequent, and on several occasions [1, 2, 11, 14, 17, 21] it has been pointed out how difficult it is to treat these symptoms, both from a diagnostic and, consequently, from a therapeutic standpoint. Therefore, it is important to emphasize the risk that a psychosocial diagnosis may imply: due to the objective difficulties related to medical investigation, hidden diseases may be overlooked [17]. Most of the publications on this subject describe a situation whose complexity starts from the interview with the patient, who can hardly communicate his own discomforts and symptoms in a precise way. The various traditional classification tools, based on patient interviews [12], do not seem to be particularly convincing. Due to the lack of concretely measurable data, they can hardly escape the patient’s subjective perception. Significant progress in the assessment of MUS and their impact can be achieved if such interviews are complemented by precise tools that provide objective measurements (see TomEEx - Extracellular Electrolyte Tomography, BIA-ACC - Advanced Clinical Body Composition Analysis and PPG Stress Flow - Analysis, monitoring and biofeedback of the autonomic nervous system and of heart rate variability) of parameters showing the patient’s health.

The role of HPA axis and chronic inflammation

The circadian rhythm of cortisol secretion is an important endogenous synchronization factor for the human body, and it should be harmonized with the current receptive state of cells as well as with the needs of the organism. In a healthy person, CRH (hypothalamus) and ACTH (pituitary gland) secretions are particularly sensitive to the decrease in cortisol levels during nighttime [36], so as to trigger the acrophase (peak concentration time) of cortisol circadian rhythm about half an hour after waking up, thus promoting the body’s stress response and adaptation processes. The increase in cortisol, once identified by the pituitary gland, causes in turn a progressive drop in ACTH secretion (retroactive HPA regulation) and thus a subsequent reduction in the activity of the adrenal glands and in cortisol secretion. However, a change in the circadian rhythm of glucocorticoids and in particular an abnormal flattening of the cortisol curve (i.e., when its secretion persists over time), due to a condition of chronic stress of the HPA axis (HPA axis index - BIA-ACC), is related to the onset of many diseases, hence the need for a convenient tool that can assess the reaction and feedback ability of the HPA axis (see TomEEx - Extracellular Electrolyte Tomography and BIA-ACC - Advanced Clinical Analysis of Body Composition). There are numerous studies on the relationships between various diseases and HPA axis imbalances, clearly showing links between abnormal glucocorticoid levels and the most varied diseases, such as depression [2, 12], anxiety and panic attacks [5, 33, 38], hippocampal hypofunction and impaired memory capacities [6], sleep disorders [6, 7, 9, 19, 27], chronic fatigue syndrome (CFS) [24], fibromyalgia and autoimmune diseases [10, 31], irritable bowel syndrome [23], hypertension [35], eating disorders and obesity [8, 18, 25, 26, 30, 32], rheumatism [4, 20] etc. The persistent activation of the HPA axis (HPA axis index: Flat Low/High - BIA-ACC) can in turn be caused by the chronicity of inflammatory processes [28, 29]. In such cases, however, the anti-inflammatory action of glucocorticoids will rapidly decline, also due to the imbalance vis-à-vis the receptivity of cells, while the increase in glucocorticoid levels and the alteration of their circadian rhythms will continue to stress the body.

From a hydroelectrolytic standpoint, chronic inflammation is locally characterized by an increase in extracellular electrolytes and a decrease in intracellular electrolytes and, at a systemic level, by dehydration and a loss of electrolytes that are recruited to the inflamed sites as they help keep the extracellular pH stable. If persistent over time, this systemic loss leads to lower electrolyte reserves, and in particular to lower phosphate and bicarbonate buffers (see Insights on extracellular tissue pH, oxidative stress and clinical observations, BIA-ACC). If persistent, the ionic decompensation in the inflamed regions leads to an alteration of the membrane potential (caused by the difference in electrolyte concentration inside and outside the cell), which can go as far as polarity reversal.

Hydroelectrolyte regulation in the presence of chronic inflammation

In order to restore the HPA axis physiological condition, it is necessary to regulate the ionic balance in chronically inflamed regions, so as to bring glucocorticoid secretion back to normal and thus restore the physiological circadian rhythms. The areas affected by chronic inflammatory processes are characterized by a high level of ionic exchange, and therefore by a current flow that is so strong as to generate an electromagnetic field, which can be detected by the biofeedback therapeutic device RegMatEx - Extracellular Matrix Regulation. Based on the spectrum analysis of the acquired signal, the device performs – after specific correction procedures (potentials, frequencies and magnitude) – a selective electromagnetic stimulation of “ionic compensation” to rebalance the level of intra-extracellular exchange in the chronically inflamed regions and thus reduce the level of inflammation by lowering the concentration of glucocorticoids. To support the device function, it is of course necessary to ensure adequate hydration and prior availability of basic electrolytes, such as bisphosphates, bicarbonates, magnesium, potassium and calcium, at a systemic level (see insights on tissue pH and oxidative stress and treatment preparation, RegMatEx).

Author: Dario Boschiero - Date: 13/11/2020

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