Treating medically unexplained physical symptoms

Chest pain, back pain, headache, muscular pains, bowel symptoms, breathlessness, dizziness, and fatigue often remain unexplained after medical assessment. 1 Such cases may be referred to as functional syndromes of chronic fatigue, chronic pain, fibromyalgia, and irritable bowel or as somatoform (somatisation) disorders. In many cases the symptoms are severe, persistent, and disabling and cause considerable personal, social, and healthcare costs.1 2 3 Furthermore, the problem is large, accounting for a quarter of general practice consultations, as many as a half of outpatient clinic attendances, and a substantial number of hospital admissions.2 When symptoms are found not to result from “genuine physical illness” they are often believed to be insignificant or attributed to mental illness. Consequently when investigations prove negative, management is commonly limited to reassurance about the absence of disease and occasionally referral to a general psychiatrist. In our experience such referrals are …