Language
Country/Area
No result found
The fog of medicine: What causes 'medically unexplained symptoms'?
In the medical field, there is a group of symptoms known as medically unexplained symptoms (MUPS or MUS). These symptoms are characterized by the fact that medical providers have not been able to find a clear medical cause during diagnosis and treatment, or their cause remains controversial. In a strict sense, the term simply means that the underlying cause of these symptoms is unclear or controversial—and that scientific consensus is lacking.
Not all medically unexplained symptoms have identifiable psychological factors.
Surveys estimate that approximately 15% to 30% of primary care consultations are for these symptoms. The National Community Survey of Canada showed that the most common medically unexplained symptoms included musculoskeletal pain, ear, nose and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue and dizziness. The causes of many of these symptoms are still under debate, including chronic fatigue syndrome, fibromyalgia, chemical sensitivity and Gulf War sickness.
The multitude of past and present terms for this syndrome reflects the imprecise and uncertain nature of its definition and attempts to avoid stigmatizing those affected. The complexity of risk factors involves psychological and biological characteristics, and these symptoms are often accompanied by other physical symptoms that can be attributed to organic diseases.
Evidence suggests that women are more likely than men to be diagnosed with medically unexplained symptoms, with childhood adversity, abuse and the death or serious illness of a close family member all significant risk factors.
Many patients experiencing these symptoms also meet diagnostic criteria for anxiety and/or depression. The greater the number of these symptoms reported, the higher the likelihood of meeting these criteria. However, anxiety and depression are also common among individuals with established disorders, and the likelihood of receiving one of these diagnoses increases with the number of symptoms reported.
Across cultures, and regardless of their etiology (explained or unexplained), it is increasingly clear that physical symptoms are associated with adverse psychosocial and functional outcomes.
Doctor-patient relationship
For cases of MUPS, the lack of a known cause can lead to conflict between patients and healthcare providers over diagnosis and treatment. Most doctors believe that MUPS may have a psychological cause, even if the person does not show signs of a psychological problem. Conversely, many patients refuse to believe that their problem is "all in the head" and believe that their symptoms must have some physical cause. This situation often causes patients to doubt the doctor's professional ability, which in turn leads to an antagonistic doctor-patient relationship.
Doctors should be careful to avoid telling patients that "there is nothing wrong" because this is clearly not true. The symptoms the patient presents are real, even if their cause is unknown.
When the cause of MUPS was found, the symptoms were no longer considered medically unexplained. For example, cases of ulcers and dyspepsia that were once thought to be MUPS became explainable once the cause was found.
In the case of chronic diseases (such as systemic erythematosus, SLE), even if the patient has been diagnosed, if the symptoms of the condition cannot be fully explained by the confirmed disease or the symptoms are considered by the doctor to be more serious than expected , may also be classified as MUPS.
TreatmentCurrently, the most effective treatment for certain medically unexplained symptoms is a multi-modality approach tailored to the individual patient. Many people with MUS require psychotherapy, relaxation therapy, and physical therapy under medical supervision. Studies have shown that this combined treatment approach is at least twice as effective as previous single therapies. Secondly, the effectiveness of cognitive behavioral therapy (CBT) has also been confirmed and supported by evidence from multiple randomized controlled trials.
While antidepressants may help, there is currently a lack of solid evidence that they are effective.
Studies have found that CBT is effective for treating symptoms such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. However, the quality of many CBT studies remains insufficient, and many lack adequate effect control. In addition, research on antidepressants is also flawed and needs further exploration and improvement.
Theory
To date, there is no consensus on the causes of MUPS. Many scholars have theorized that medically unexplained symptoms may be a response to psychological trauma or distress. Modern theories pay more attention to the individual's personality and psychological characteristics. For example, people who are anxious or depressed, or who are overly concerned about their physical condition, may be more likely to experience these symptoms. For some MUPS, particularly those associated with recognized syndromes (eg, chronic fatigue syndrome, fibromyalgia), there is wide disagreement among disciplines regarding their etiology.
While research in psychology and psychiatry often emphasizes psychological factors, research in the biomedical sciences in fields such as immunology and rheumatology tends to focus more on biological factors. However, in this medical fog, what factors dominate the occurrence of MUPS?
