This book aims to help general practitioners (GPs) and other generalists to understand and treat conditions associated with symptoms that appear not to be caused by physical disease. This lack of explanation due to visible pathology means they are often called medically unexplained symptoms (MUS). This book takes the view that MUS are disorders of function, rather than structure, and so the book will refer to them as functional symptoms. Although we do not fully understand the nature of the disturbed function, research is making this clearer and several mechanisms, including physiological, neurological and cognitive processes play a part in symptoms. This book also takes the view that by using what is currently known about functional symptoms, it is possible to develop coherent and plausible models to explain what is going on. This book aims to help doctors explain the medically unexplained – both to themselves and to their patients. Symptoms that appear not to be caused by physical disease are a challenge to doctors and patients. Both have to simultaneously consider the possibility of serious illness (either physical or mental) while seeking to contain and reduce the symptoms and the threat they represent.
This is not easy. In order to deal with MUS, and the patients who present with them, doctors need to apply a range of clinical skills: from empathic history taking and ABC of Medically Unexplained Symptoms, First Edition. Edited by Christopher Burton. © 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. focused examination, through careful assessment of probabilities, to communication, explanation and – sometimes – support. This book assumes you already have those skills to some extent; it aims to show ways of using, and developing, them in order to deal with these common problems. An approach to MUS TheABCof Medically Unexplained Symptoms is not a book about the somatisation of mental distress from a psychoanalytic perspective. It does not take the view that unexplained symptoms are a way of communicating need in people who cannot otherwise do so. Rather it takes a mechanistic view of symptoms as the result of interacting processes – some physiological, some neuropsychological – that lead to persistent unpleasant feelings and distress. This approach is similar to that used in pain medicine, with which it has much in common; indeed many unexplained symptoms and syndromes include pain. This introductory chapter addresses three questions: what do we mean by medically unexplained symptoms; what causes medically unexplained symptoms; and what should we call medically unexplained symptoms?