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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Medically unexplained physical symptoms | 2/2 | https://en.wikipedia.org/wiki/Medically_unexplained_physical_symptoms | reference | science, encyclopedia | 2026-05-05T07:30:49.258781+00:00 | kb-cron |
The most effective current treatment for some medically unexplained symptoms is a combination of therapeutic approaches tailored to the individual patient. Most MUS patients are in need of psychotherapy, relaxation therapy and physiotherapy under medical supervision. A combined therapeutic approach which is at least twice as effective as other therapeutic modalities published to date is described in Steele RE et al. "A novel and effective treatment modality for medically unexplained symptoms". The next best documented approach is cognitive behavioral therapy (CBT), with evidence from multiple randomized controlled trials. Antidepressants may also help, but the evidence is "not yet conclusive." The effectiveness of CBT and antidepressants has not been studied for all medically unexplained symptoms, however. Evidence for a positive effect of CBT has been found in trials for fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, unexplained headaches, unexplained back pain, tinnitus, and non-cardiac chest pain. Overall, CBT has been shown to be effective in reducing psychological distress and improving medical status in MUPS patients. However the quality of many CBT studies remains low, and many studies lack an attention-placebo control. As of 2006, CBT had not been tested for menopausal syndrome, chronic facial pain, interstitial cystitis, or chronic pelvic pain. Some high quality studies have been conducted examining the effectiveness of antidepressants in MUPS. Those antidepressants that have been investigated include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). For example, TCAs have effects on IBS, fibromyalgia, back pain, headaches, and possibly tinnitus, and single studies show a possible effect in chronic facial pain, non-cardiac chest pain, and interstitial cystitis. SSRIs are usually not effective or have only a weak effect. One exception is menopausal syndrome, where SSRIs are "possibly effective" as well as a third class of antidepressants, the serotonin-norepinephrine reuptake inhibitors (SNRIs). A 2010 Cochrane review examined the use of Consultation Letters for MUPS with psychiatrist and found some evidence of their effectiveness in terms of medical cost and patient physical functioning. The studies reviewed were small and of moderate quality and completed primarily in the United States so generalizing results to other settings should be done with caution.
=== Theories === There is no consensus as to what causes MUPS. However, a number of theories have been put forward. Many of these share the common assumption that MUPS are somehow caused by psychological distress or disturbance. One classical theory is that MUPS arise as a reaction to childhood trauma in vulnerable individuals. More contemporary theories place less emphasis on trauma and suggest that an individual's personality and psychological characteristics play a central role. For example, it has been suggested that people who have anxiety or depression or who focus excessively on their body might be particularly prone to these symptoms. For certain MUPSs that occur within recognized syndromes (e.g. chronic fatigue syndrome and fibromyalgia), there is wide disagreement across disciplines as to the causes of the symptoms. Research in the domains of psychology and psychiatry frequently emphasizes psychological causal factors, whereas research in the biomedical sciences – relating to immunology and rheumatology, for example – commonly emphasizes biological factors.
== See also == Amplified musculoskeletal pain syndrome Cryptogenic disease Culture-bound syndrome Diagnosis of exclusion Functional disorder Idiopathy Idiosyncratic drug reaction Somatoform disorders
== References ==
== External links == Medically Unexplained Physical Symptoms DHCC/DOD Pamphlet. Medically unexplained physical symptoms R. Mayou, British Medical Journal, 1991 September 7: 534–535.