Medicines for Medically unexplained symptoms

What it is

Medically unexplained symptoms (sometimes called persistent physical symptoms or functional symptoms) are physical symptoms that a person genuinely experiences, but for which medical tests and assessments do not find a clear underlying disease or structural cause. This is common — many people experience symptoms at some point for which no specific disease is found. A very important point is that these symptoms are real and genuinely experienced — they are not "imagined" or "made up", and having medically unexplained symptoms does not mean the symptoms are not genuine or that the person is not really suffering; it simply means that the usual tests have not identified a specific disease as the cause. The symptoms can be varied and can affect any part of the body — common examples include pain (such as widespread pain, headaches, tummy pain, or chest pain), tiredness and fatigue, dizziness, palpitations, bowel symptoms, and many others — and they can be persistent, distressing, and significantly affect a person’s daily life, function, and wellbeing. The reasons why symptoms occur without a clear disease cause are complex and not fully understood, but are thought to involve a genuine interplay of physical, psychological, and other factors — for example, the way the body and nervous system function and process signals, and the effects of stress, mood, and other factors, which can all contribute to real physical symptoms; this is sometimes described in terms of how the body and mind work together, and does not mean the symptoms are "all in the mind". Medically unexplained symptoms can also occur alongside, or overlap with, recognised conditions (including some functional disorders, such as irritable bowel syndrome or others). It is important that people with these symptoms are taken seriously, that appropriate assessment is done to look for any treatable cause, and that, where no specific disease is found, the focus shifts to managing the symptoms, improving function and wellbeing, and supporting the person — rather than the person feeling dismissed. A range of approaches can help, including addressing the symptoms and their impact, support, and, for some, psychological approaches (which help with the symptoms and their impact, not because the symptoms are "not real"). The key messages are that medically unexplained symptoms are real, often distressing physical symptoms for which tests do not find a clear disease cause, that they are genuine and the person should be taken seriously, and that support focuses on managing the symptoms and improving wellbeing.

How it is treated

Medically unexplained symptoms are managed by taking the person and their symptoms seriously, appropriate assessment to look for any treatable cause, and then a focus on managing the symptoms, improving function and wellbeing, and supporting the person — recognising the symptoms as genuine throughout. A crucial foundation is that the symptoms are real and the person is taken seriously; feeling believed and understood is important, and the aim is to help, not to dismiss. Appropriate assessment is carried out to look for any underlying treatable cause of the symptoms, guided by the symptoms; where investigations do not identify a specific disease, it is helpful for the person to understand that this is a genuine and common situation, that the symptoms are real, and that the focus can helpfully shift towards managing the symptoms and their impact and improving wellbeing, rather than continuing endless investigations (which are often unhelpful once serious causes have been reasonably excluded, and can themselves cause worry). Explaining the symptoms in an understandable, validating way (for example, in terms of how the body and nervous system function and process signals, and how factors such as stress and mood can genuinely contribute to real physical symptoms) can help the person make sense of their experience without feeling dismissed. Management then focuses on approaches that can help the symptoms and the person’s functioning and wellbeing, tailored to the individual, and may include: measures to manage specific symptoms (such as pain management approaches, or treatments for particular symptoms); general measures that support wellbeing and can help symptoms (such as gradually increasing activity where appropriate, managing sleep, a balanced routine, and managing stress); addressing any contributing factors (such as stress, low mood, or anxiety, which can contribute to and be worsened by physical symptoms, and which can be supported); and, for some people, psychological approaches — such as cognitive behavioural therapy (CBT) or other therapies — which can help people manage the symptoms and their impact and improve functioning (offered as a way of helping with the symptoms, not because the symptoms are "not real"); support and self-management strategies also help. A supportive, ongoing relationship with a health professional (such as a GP), a consistent approach, and support all help, and, where relevant, specialist services for persistent physical symptoms may be involved. It is important that any new or changing symptoms, or "red flag" features, are still assessed appropriately, as medically unexplained symptoms do not preclude the possibility of a treatable condition developing. The reassuring and important messages are that medically unexplained symptoms are real and genuinely experienced (not imagined or made up), that the person should be taken seriously and appropriate assessment done, and that a range of approaches — managing the symptoms, supporting wellbeing and function, addressing contributing factors, and, for some, psychological approaches — can help people manage the symptoms and improve their quality of life; so being taken seriously, appropriate assessment, and a focus on managing symptoms and wellbeing are the keys.