Dizziness and Back Pain: A Guide to Autonomic Nervous System Disorders

Q: Dizziness and Back Pain: A Guide to Autonomic Nervous System Disorders

Hello, based on your description： in addition to autonomic nervous system issues, it may be necessary to consider the possibility of arrhythmias. <br>Furthermore, sleep apnea could also exacerbate the symptoms. <br>Our autonomic nervous system is regulated by the sympathetic and

Dizziness, back pain, and sweating of the hands?

Hello Doctor, I have been experiencing dizziness frequently in the mornings, around 8 to 10 AM, which makes it difficult for me to concentrate at work.
Before the dizziness occurs, I often feel a soreness in my back or a sensation as if something is pressing on it.
Then, I feel a rush of blood or heat flowing from my back to my head, followed by dizziness (sometimes it feels like the room is spinning).
I also experience shortness of breath, a feeling of pressure in my chest, and an increased heart rate.
After that, my limbs feel weak, I sweat from my hands, and I feel nauseous when eating.
This episode lasts about 2 to 5 minutes and is very uncomfortable, occurring approximately 3 to 5 times a day.
Sometimes, it doesn't happen in the morning but occurs at random times, and the sensation resolves quickly.
The frequency increases when I have a cold.
Once, during a viral infection, I experienced additional symptoms of chest tightness and whole-body tremors, lasting about 5 to 10 minutes (I was fully conscious at the time), but after an EEG, the doctor found no significant issues.
This dizziness phenomenon has been with me for over 5 years, starting after I had been staying up late and waking up early due to report deadlines.
I remember the first episode was characterized by severe dizziness, chest pressure, and a rapid heartbeat, along with my palms sweating and turning purple.
The doctor administered a sedative, and after resting, I felt much better, but the sensation persisted for two to three months.
Over the past 5 years, I have consulted various specialists at the same medical center, including cardiology, hepatobiliary and gastroenterology, pulmonology, neurology, and family medicine.
1.
Cardiology: An echocardiogram and ECG showed no significant issues, only mild mitral and tricuspid valve prolapse (the doctor said not to worry).
2.
Hepatobiliary and Gastroenterology: Mild fatty liver was detected (the doctor said it was not serious).
Since developing these symptoms, I have experienced frequent stomach pain and spasms.
An endoscopy revealed gastroesophageal reflux disease, which improved significantly with medication.
3.
Pulmonology: No symptoms were found.
4.
Neurology: An EEG showed no significant issues, and the doctor diagnosed autonomic nervous system dysfunction, prescribing anti-anxiety medication.
5.
Family Medicine: High cholesterol (currently managed with medication and regular blood tests).
Whenever I experience dizziness, I visit the cardiology or neurology departments for examinations, but most doctors say there is nothing wrong.
Neurologists prescribe anti-anxiety and pain relief medications, advising me to take them when I feel uncomfortable, but sometimes I still feel uneasy even after taking the medication.
The inability to identify the cause of my symptoms over the past 5 years has been very distressing.
During episodes, I feel extremely dizzy and fear having a stroke, but I do not experience any paralysis or difficulty with my limbs.

Last year and the year before, my symptoms improved significantly, and I had a period without these symptoms.
However, after catching a cold this year, the symptoms have returned.
The neurologist mentioned autonomic nervous system dysfunction; is that really the case? How can autonomic nervous system dysfunction be diagnosed? Are there any tests to determine the severity of the dysfunction? Could other conditions cause these symptoms? Should I undergo further examinations of other areas of my body? I have a family to support, and I need to focus on work.
This situation is causing me great concern for my health.
Thank you, Doctor, for taking the time to read my inquiry.
I am very troubled by this phenomenon and fear I might faint.
I am also struggling to eat well and concentrate at work.
I hope you can provide me with some advice, and I wish for my health to improve.
Thank you.

Lewis, 30~39 year old female. Ask Date: 2020/03/05

Dr. Jiang Junyi reply Neurology

Hello, based on your description: in addition to autonomic nervous system issues, it may be necessary to consider the possibility of arrhythmias.
Furthermore, sleep apnea could also exacerbate the symptoms.
Our autonomic nervous system is regulated by the sympathetic and parasympathetic nervous systems; one acts as the accelerator and the other as the brake.
The sympathetic nervous system is responsible for accelerating the heart rate, increasing respiration, and enhancing sweating during activities.
Once the activity ceases, the parasympathetic nervous system takes over, slowing the heart rate, decreasing respiration, and reducing sweating.
This could explain the dizziness you mentioned.
Regarding the risk of stroke, it is important to evaluate your cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes, and smoking.
For autonomic nervous system assessment, heart rate variability testing or sympathetic nerve stimulation may be arranged.
I recommend consulting a neurologist to discuss further examinations and treatments.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Hospital is concerned about you.

Reply Date: 2020/03/05

More Info

Your symptoms of dizziness, back pain, and associated autonomic nervous system (ANS) disturbances are indeed concerning and can significantly impact your quality of life. Based on your detailed description, it appears that you may be experiencing a combination of issues related to the autonomic nervous system, which regulates involuntary bodily functions, and possibly other underlying conditions.

Understanding Your Symptoms
1. Dizziness: The episodes of dizziness you describe, particularly occurring in the morning and accompanied by sensations of pressure in the back, could be indicative of several conditions. These may include orthostatic hypotension (a drop in blood pressure upon standing), vestibular disorders, or even anxiety-related symptoms. The fact that you experience a rush of warmth or blood flow to the head suggests a possible vascular component, which could be related to your autonomic nervous system's regulation of blood flow.

2. Back Pain: The sensation of pressure in your back prior to dizziness could be linked to muscle tension or spinal issues. Chronic stress and anxiety can lead to muscle tightness, particularly in the back, which may contribute to your symptoms. Additionally, if there are any underlying spinal issues, such as herniated discs or nerve compression, these could also manifest as back pain and potentially affect your balance and coordination.

3. Autonomic Nervous System Dysfunction: Your history of anxiety and the diagnosis of autonomic nervous system dysfunction suggest that your symptoms may be exacerbated by stress and anxiety. The ANS is divided into the sympathetic and parasympathetic systems, and dysregulation can lead to symptoms such as palpitations, sweating, dizziness, and gastrointestinal issues. The fact that your symptoms have worsened after viral infections may indicate that your body is struggling to regain balance after the illness.

Diagnostic Considerations
Given your extensive medical history and the various specialists you have consulted, it may be beneficial to consider the following:
- Comprehensive Autonomic Testing: This can include tilt-table testing, heart rate variability analysis, and other assessments to evaluate how well your autonomic nervous system is functioning. These tests can help determine if there is a significant dysregulation that needs to be addressed.

- Neurological Evaluation: Since you have experienced episodes of dizziness and other neurological symptoms, a thorough evaluation by a neurologist may be warranted. This could include advanced imaging studies like MRI or CT scans to rule out any structural abnormalities.

- Psychological Assessment: Given the anxiety component, a referral to a psychologist or psychiatrist may be beneficial. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can help manage anxiety and its physical manifestations.

Management Strategies
1. Lifestyle Modifications: Regular physical activity, hydration, and a balanced diet can help improve overall health and may alleviate some symptoms. Practices such as yoga or tai chi can also promote relaxation and improve balance.

2. Medication Review: If you are currently taking medications for anxiety or other conditions, it may be worth discussing with your healthcare provider whether these are adequately addressing your symptoms or if adjustments are needed.

3. Stress Management Techniques: Mindfulness, meditation, and breathing exercises can help manage anxiety and may reduce the frequency and severity of your symptoms.

4. Regular Follow-ups: Continuous monitoring of your symptoms and regular check-ins with your healthcare providers can help ensure that any changes in your condition are promptly addressed.

Conclusion
Your symptoms are complex and multifaceted, and while autonomic nervous system dysfunction may play a significant role, it is essential to consider other potential underlying causes. A comprehensive approach involving various specialists may provide the best pathway to understanding and managing your condition. Remember, you are not alone in this, and with the right support and interventions, it is possible to improve your quality of life. Please continue to advocate for your health and seek the care you need.

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