The Neuro-Immune-Sympathetic-Endocrine Project - Part 1: Overview (NISE Syndrome Project)

Yes we Can!

Finally, we can treat almost all (>97%) chronic pain presentations

If you rehabilitate or treat pain you should know this

Background

The extensive literature reviews we have done with the pattern "what is different between normal subjects and (insert condition)" have paid off enormously. It has been apparent for a long time that there has not been a proper sub-classification to address the sympathetic and endocrine symptoms those with chronic pain complain of. This was almost the topic of my PhD over a decade ago. It may have been best for it to wait since there wasn't really enough research published back then to give enough insight to solve the problem. But now there is and it has been solved.

Following The Learning Project, The Pain Project and The Body Image Project, we had some exceptionally advanced rehabilitation based on cutting edge neuroscience. But there were still non responders or others that only marginally responded. A closer look at this group revealed the inevitable: widespread bodily symptoms relating to immune, sympathetic, and endocrine complaints as well as others that were not really characterized (but we now appreciate they fall into those categories).

As before, I started a project of sub-classifying this group. The goal was to be able to screen the group, and then develop intervention strategies. Unfortunately there was not an existing tool that was accurate enough. One tool has potential, but failed in the end so there was a need to develop a tool. We did a literature review of all immune, sympathetic and endocrine symptoms that occurred with pain conditions. From this I developed a symptom based screening tool. What made this project possible was the previous work which helped in the identification of the target group. After a few rounds of questionnaires and statistics I had the items reduced to something manageable. Further work is needed to reduce the number of items, but in reality this does need to be a longer questionnaire than is  normally used given the nature of the symptoms. Of course as usual, a good subjective history precludes the need to administer it. In brief, subjects had symptoms across all 18 bodily systems. I termed this "Neuro-immune-sympathetic-endocrine (dys-regulation) syndrome" (NISE Syndrome).

•      A constellation of interconnected physiological, biochemical processes (and axes) that when dys-regulated (range of subtle to overt)

–     Can have a range of systemic effects

–     Increases the risk of a variety of diseases and symptoms

–     Chronic low grade inflammation

–     Metabolic inflammation

–     Neurogenic inflammation

–     May be involved in auto-immune disease

A few other points:

• In reality, you have NISE dys-regulation long before you have symptoms across all bodily systems.
• By the time you diseases or symptoms related to NISE dys-regulation, you have had multiple bodily systems in dys-regulation for some time and are at a large risk for more symptoms
• We are currently assessing the need to expand the definition to reduce the number of bodily systems. It is quite likely this will occur, however the research needs to be done first.

The next step was to develop an intervention. The results of our prospective cohort type study (large consecutive case series with appropriate inclusion/exclusion criteria) have revealed amazing results. All subjects who complied had significant improvement (range 50% - 100%) in multiple outcome measures. What was more amazing, was that it occurred very quickly. Within 2-3 weeks of compliance in most. Symptoms, of systemic and neurogenic inflammation vanished; symptoms of autoimmune diseases improved or cleared, medications were stopped. Clearly this was the start of something very important and is an area of ongoing research.

The NISE Syndrome Project highlighted the need to:

• perform a review of all bodily systems (the questionnaire)
• screen for central sensitivity syndromes
• co-morbid medical conditions
• take a three generation pedigree related to these

We can be confident that in almost everyone now, we have a rehabilitation directive that can address almost everyone. Wouldn't it be great to be a new graduate now so you don't have to supper with the failures that everyone else had to!

Sean GT Gibbons BSc (Hons) PT, MSc Ergonomics, PhD (c), MCPA

Reference

Gibbons SGT 2016 Preliminary development of items to identify a neuro-immune-autonomic-endocrine involvement in complex pain presentations. Proceedings of "Expanding Horizons": The 11^th International Conference of IFOMT. July 4-8; Glasgow, Scotland