Medically unexplained physical symptoms: Difference between revisions
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Genetic influences are suggested by a [[twin study]] that examined clustering of illnesses such as [[chronic fatigue syndrome]], [[low back pain]], [[irritable bowel syndrome]], chronic tension [[headache]], [[fibromyalgia]], [[temporomandibular joint disorder]], major [[depression]], [[panic attack]]s, and [[posttraumatic stress disorder]].<ref name="pmid17503107">{{cite journal |author=Schur EA, Afari N, Furberg H, ''et al'' |title=Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions |journal=Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine |volume=22 |issue=6 |pages=818–21 |year=2007 |pmid=17503107 |doi=10.1007/s11606-007-0140-5}}</ref> This study found significant clustering suggesting a common, but not understood, underlying cause. | |||
Environmental influences are suggested by the association between major life stresses and somatic symptoms.<ref>Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. | |||
Lancet 2008. {{doi|10.1016/S0140-6736(08)60522-X}}</ref> | |||
The associations between psychological stress and medical illnesses may be due to either subtle physiological changes induced by the stress, or may be due to the stress leading to increased seeking of medical care.<ref name="pmid10204966">{{cite journal |author=Herschbach P, Henrich G, von Rad M |title=Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior? |journal=Psychosomatic medicine |volume=61 |issue=2 |pages=148–53 |year=1999 |pmid=10204966 |doi=}}</ref> | The associations between psychological stress and medical illnesses may be due to either subtle physiological changes induced by the stress, or may be due to the stress leading to increased seeking of medical care.<ref name="pmid10204966">{{cite journal |author=Herschbach P, Henrich G, von Rad M |title=Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior? |journal=Psychosomatic medicine |volume=61 |issue=2 |pages=148–53 |year=1999 |pmid=10204966 |doi=}}</ref> | ||
Revision as of 07:59, 4 April 2008
Medically unexplained physical symptoms or MUPS is a term used in health care to describe a situation where an individual suffers from multiple physical symptoms for which the physician or other healthcare provider has found no physical cause.[1] Up to 30% of all primary care consultations are patients with medically unexplained symptoms.
History and usage
The term medically unexplained physical symptoms was first used in 1987 by D.I. Melville.[2]
MUPS is not synonymous with somatization disorder or psychosomatic illness where the cause or perception of symptoms is mental in origin. Instead, MUPS refers to the clinical situation where the cause of the symptoms cannot be determined, but might include somatic, physical or environmental causes.
However, several definitions of both somatization and MUPS exist, and the usage of both terms is not consistent in medical literature and practice. MUPS is sometimes used interchangeably with both somatization and functional somatic symptoms. [3]
Cause
Genetic influences are suggested by a twin study that examined clustering of illnesses such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, chronic tension headache, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and posttraumatic stress disorder.[4] This study found significant clustering suggesting a common, but not understood, underlying cause.
Environmental influences are suggested by the association between major life stresses and somatic symptoms.[5]
The associations between psychological stress and medical illnesses may be due to either subtle physiological changes induced by the stress, or may be due to the stress leading to increased seeking of medical care.[6]
Controversy
The lack of etiology diagnosis in MUPS cases can lead to conflict between patient and health-care provider over the diagnosis and treatment of MUPS. This conflict can occur in the public arena and may involve media controversy, advocacy groups, scientific and political debate and even legal proceedings [7].
Diagnosis of MUPS is seldom a satisfactory situation for the patient, as many patients feel this implies it is "all in their head." This can lead to an adversarial doctor-patient relationship[7], which can develop into an iatrogenic neurosis, thus complicating the situation.
Treatment
An empathetic approach by the doctor from the beginning may be helpful.[8] A randomized controlled trial found improvement using multi-faceted, collaborative care.[9]
References
- ↑ Kroenke K, Rosmalen JG (2006). "Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders". Med. Clin. North Am. 90 (4): 603–26. DOI:10.1016/j.mcna.2006.04.003. PMID 16843765. Research Blogging.
- ↑ Descriptive clinical research and medically unexplained physical symptoms. Melville, D.I., Journal of Psychosomatic Research, 1987;31(3):359-65.
- ↑ Somatization, heartsink patients, or functional somatic symptoms? Resendal, et al, Scandinavian Journal of Primary Health Care, 2005; 23: 3-10
- ↑ Schur EA, Afari N, Furberg H, et al (2007). "Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 22 (6): 818–21. DOI:10.1007/s11606-007-0140-5. PMID 17503107. Research Blogging.
- ↑ Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. Lancet 2008. DOI:10.1016/S0140-6736(08)60522-X
- ↑ Herschbach P, Henrich G, von Rad M (1999). "Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior?". Psychosomatic medicine 61 (2): 148–53. PMID 10204966. [e]
- ↑ 7.0 7.1 Caring for Medically Unexplained Physical Symptoms after Toxic Environmental Exposures: Effects of Contested Causation Engel, et al. Environmental Health Perspectives, Vol 110, Nu. S4, August 2002.
- ↑ Epstein; Hadee, Carroll, Meldrum, Lardner, Shields (2007-12-17). "Could his Be Something Serious?". Journal of General Internal Medicine 22 (12): 1731-1739. DOI:10.1007/s11606-007-0416-9. Retrieved on 2007-11-27. Research Blogging.
- ↑ Smith RC, Lyles JS, Gardiner JC, et al (2006). "Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 21 (7): 671-7. DOI:10.1111/j.1525-1497.2006.00460.x. PMID 16808764. Research Blogging.