What do guidelines and systematic reviews tell us about the management of medically unexplained symptoms in primary care?

Olde Hartman, T. C., Rosendal, M., Aamland, A., van der Horst, H. E., Rosmalen, J. G., Burton, C. D. & Lucassen, P. L., 2017, In : BJGP open. 1, 3, 7 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • Tim C Olde Hartman
  • Marianne Rosendal
  • Aase Aamland
  • Henriette E van der Horst
  • Judith Gm Rosmalen
  • Chris D Burton
  • Peter Lbj Lucassen
Medically unexplained symptoms (MUS) are symptoms for which the origin remains unclear despite adequate history taking, physical examination, and additional investigations.1 An estimated 3–11% of patients visiting general practice repeatedly consult their GP for MUS.2,3 MUS exist along a continuum ranging from self-limiting symptoms, to recurrent and persistent symptoms, through to symptom disorders.4 Although there are various terms for the condition, for example unexplained physical symptoms, functional symptoms, or somatoform symptoms, we have chosen to use MUS in this article because this is the most frequently used term. This review aims to address current problems with the management of undifferentiated MUS; specific syndromes within the MUS spectrum, such as chronic fatigue syndrome and irritable bowel syndrome, are excluded from discussion.

Patients with persistent MUS suffer from their symptoms, are functionally impaired, and are at risk of potentially harmful additional testing and treatment.5 Furthermore, these patients commonly express dissatisfaction with the medical care they receive during their illness.6 They feel stigmatised and not taken seriously.7 GPs often experience patients with persistent MUS as difficult and frustrating to manage.8 In addition, MUS are associated with reduced health-related quality of life, higher healthcare and social costs, and costs associated with lost productivity.9,10

The effects of many treatment strategies have been studied in recent decades. However, not all interventions are acceptable or feasible in routine primary care. In the light of the central role of the GP in managing MUS, we will discuss the importance of consultation skills and the effects of specific treatments in primary care. We will do this by way of a narrative review using available national guidelines and Cochrane Reviews in this field.
Original languageEnglish
Number of pages7
JournalBJGP open
Issue number3
Publication statusPublished - 2017

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