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ave you ever experienced unexplained pain? Learn about common manifestations of medically unexplained symptom
Medically unexplained physiological symptoms (MUPS or MUS) are symptoms for which a physician or other healthcare provider cannot find a medical cause, or whose cause remains controversial. One of the most basic definitions of this condition is that its cause is unknown or controversial, and there is no scientific consensus. At the same time, these symptoms are not necessarily all influenced by identifiable psychological factors.
Studies show that approximately 15% to 30% of primary care consultations are for medically unexplained symptoms.
In a large Canadian community survey, the most common medically unexplained symptoms included musculoskeletal pain, ear, nose and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue and dizziness. The term MUPS is also often used to refer to syndromes whose causes remain controversial, such as chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, and Gulf Warrior disease. The diversity of these terms reflects the uncertainty and controversy surrounding the definition of these symptoms, as well as the medical community's efforts to avoid stigmatizing those affected.
Currently, the risk factors for MUPS are complex, including both psychological and organic factors. These symptoms are often accompanied by other physical symptoms caused by organic illness, so the lines that define certain symptoms as medically unexplained are becoming increasingly blurred. Notably, women were significantly more likely than men to be diagnosed with medically unexplained symptoms, and childhood adversity and/or abuse, as well as the death of a close family member or major illness, were significant risk factors.
Many patients who present with medically unexplained symptoms also meet diagnostic criteria for anxiety and/or depression, and the greater the number of these symptoms reported, the higher the likelihood of meeting these criteria.
The lack of a known cause for MUPS often leads to conflicts over diagnosis and treatment between doctors and patients. Most doctors believe that MUPS probably has a psychological cause, even if the patient shows no evidence of psychological problems; many patients refuse to think that their problems are "all in the head" and believe that their illness has a physical cause. This makes the diagnosis of MUPS often unsatisfactory in the minds of patients and may lead to tension in the doctor-patient relationship.
For example, a 2008 review of British Medical Journals noted that doctors must be careful not to tell patients "there's nothing wrong, because that's clearly not true." The symptoms a patient is experiencing are real, even if their cause is unclear. Physicians should strive to explain symptoms, avoid placing blame on the patient, and work with the patient to develop a plan for managing symptoms.
When the cause of MUPS is discovered, the condition is no longer considered medically unexplained. Certain cases of ulcers and indigestion were once thought to be MUPS until bacterial infection was found as the cause. However, patients who experience one or more unexplained symptoms despite having a known medical condition may still be considered to have MUPS.
The most effective current treatments are combination therapies tailored to the individual patient. Most people with MUPS require psychotherapy, relaxation therapy, and medically supervised physical therapy.
A combined treatment regimen that is at least twice as effective as any other currently published therapy was proposed by Steele RE et al. However, cognitive behavioral therapy (CBT) is another treatment approach that is well documented and has evidence from multiple randomized controlled trials showing efficacy. Although antidepressants may help, the current evidence is inconclusive.
CBT has shown effectiveness in reducing psychological distress and improving medical status in patients with MUPS, however many studies were of low quality and no placebo control group was available. Therefore, the efficacy of CBT for certain MUPS still needs further investigation.
Another striking point is that there remains widespread disagreement about the root causes of MUPS. While many theories favor the idea that MUPS stem from psychological anxiety or stress, there are differing opinions about which individuals are most susceptible to developing these symptoms. Some researchers emphasize that personality and psychological traits may play a central role in this process.
In today's society, more and more patients are facing physical symptoms that cannot be explained by medicine. In such contexts, how can we understand the sources of these symptoms so that we can better support those who suffer from them?
