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Medically unexplained symptoms are linked to chronic inflammatory diseases - Is there a role for frontal cerebral blood oxygen content?

Neuroimmunomodulation 2024 January 13
Introduction Patients often go to the physician with medically unexplained symptoms (MUS). MUS can be autonomic nervous system-related 'unspecific' symptoms, such as palpitations, hearth rhythm alterations, tempera-ture dysregulation (hand, feet), anxiety or MUS can be depressive manifestations, fatigue, somnolence, nausea, hyperalgesia with varying pains and aches, dizziness, etc. Methods In this real-world study, we investigated MUS in a cohort of unselected outpatients from general practi-tioners in Italy. It was our aim to increase the understanding of MUS by using principal component analyses to identify any subcategories of MUS and to check a role of chronic inflammatory diseases. Additionally, we studied cerebral blood oxygen and associations with MUS and chronic inflammatory disease. Results Participants included 1597 subjects (50.6+/-0.4 years, 65%/35% women/men). According to ICD-10 codes, 137 subjects had chronic inflammatory diseases. MUS were checked by a questionnaire with numeric rating scale and cerebral blood flow with optical techniques. The analyses of men and women were strati-fied. Psychological symptom severity was higher in the inflamed compared to the non-inflamed group (fatigue, insomnia in women and men; recent mood changes, daytime sleepiness, anxiety, apathy, cold hands only in women; abnormal appetite and heart rhythm problems only in men). Principal component analysis with MUS provided new subcategories: brain symptoms, gut symptoms and unspecific symp-toms. Brain and gut symptoms were higher in inflamed women and men. Chronic inflammatory diseases and pain were tightly interrelated in men and women (p<0.0001). In women, not in men, average frontal rCBO2 content was higher in inflamed compared to non-inflamed subjects. In men, not in women, individ-uals with pain demonstrated a lower average frontal rCBO2 content compared to pain-free men. MUS did not related to rCBO2 parameters. Conclusion This study shows close relationships between MUS and chronic inflammatory diseases but not between MUS and rCBO2 parameters.

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