Misplaced Pages

Revision as of 18:48, 18 December 2008

Medically unexplained physical symptoms (MUPS), or medically unexplained symptoms (MUS), is a term sometimes 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. Up to 30% of all primary care consultations are patients with medically unexplained symptoms. The term is commonly used to refer to Gulf War illness and more occasionally to other symptom-based diagnoses such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity. The term does not necessarily imply that a physical cause does not exist, and as more becomes known about a disorder (as is the case with chronic fatigue syndrome) it may be applied less often.

History and usage

The term medically unexplained physical symptoms was first used in 1987 by D.I. Melville.

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 psychiatric, physical and/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.

Contested causation

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 .

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, which can develop into an iatrogenic neurosis, thus complicating the situation.

According to psychiatrist Simon Wessely, "Various names have been given to medically unexplained symptoms. These include somatisation, somatoform disorders and functional somatic symptoms." He continues to claim "that a substantial overlap exists between the individual syndromes and that the similarities between them outweigh the differences". In another publication, Wessely warns that "the conferring of an illness label is not a neutral act, since specific labels are associated with specific beliefs and attitudes", and "even when organic illness is certain, the illness label can result in adverse behaviour changes".

Wessely's views have been met with considerable criticism. Bell and Lapp argue that "the existence of an illness is not dependent on a reliable, objective marker to identify the condition, or upon knowledge of aetiology".

Treatment

A randomized controlled trial found some improvement in mental health using multi-faceted, collaborative care. Of particular value to the majority of participants showing improvement during the study is due to antidepressants (including 100% of all patients with multiple chemical sensitivity); however, 20% of other participants showed improvement despite not taking antidepressants. In this study, participating in other forms of mental health care tripled compliance with taking antidepressants and may have helped those patients not taking medications. In a survey of patients with chronic fatigue syndrome, just as many respondents felt worse from antidepressants as there were to report improvement.

References

1. Explaining Medically Unexplained Symptoms Laurence J Kirmayer, MD, The Canadian Journal of Psychiatry, October 2004
2. Population and Need-Based Prevention of Unexplained Physical Symptoms in the Community Engel, et al, U.S.Army.
3. Descriptive clinical research and medically unexplained physical symptoms. Melville, D.I., Journal of Psychosomatic Research, 1987;31(3):359-65.
4. Rosendal M, Fink P, Bro F, Olesen F (2005). "Somatization, heartsink patients, or functional somatic symptoms? Towards a clinical useful classification in primary health care". Scandinavian Journal of Primary Health Care. 21 (1): 3–10. PMID 16025867.{{cite journal}}: CS1 maint: multiple names: authors list (link)
5. ^ 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.
6. Wessely S, Nimnuan C, Sharpe M (1999). "Functional somatic syndromes: one or many?". Lancet. 354 (9182): 936–9. doi:10.1016/S0140-6736(98)08320-2. PMID 10489969.{{cite journal}}: CS1 maint: multiple names: authors list (link)
7. Page LA, S Wessely S, Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. Journal of the Royal Society of Medicine 2003:96:223-227
8. Goudsmit E, Doorduin T, "Is CFS a functional somatic syndrome?", 2000
9. Bell D, Lapp C, "Letter to the editor of the Annals of Internal Medicine", Newsletter AAFCFS, Aug/Sep. 1999
10. 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. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
11. De Veer AJE, Francke AL (2008), 20081217 "Zorg voor ME/CVS-patiënten. Ervaringen van de achterban van patiëntenorganisaties met de Gezondheidszorg", NIVEL, Dec (in Dutch).

See also

• Culture-bound syndrome
• Somatoform disorders

External links

• Medically Unexplained Physical Symptoms DHCC/DOD Pamphlet.
• Medically unexplained physical symptoms R. Mayou, British Medical Journal, 1991 September 7: 534–535.

• Medical terms
• Symptoms