What are Medically Unexplained Physical Symptoms (MUPS)?

The symptoms that bring a patient to a doctor are real, even when a cause is not known. The lack of a cause for a patient’s symptoms can be distressing for the patient and frustrating for the doctor. A large of number of patients in General Practice are investigated and the symptoms remain ‘medically unexplained’.  It is important to stress that this term does not necessarily imply that a physical cause doesn’t exist but rather that a cause for the symptoms may be unexplained by clinical diagnostic tests.

These physical symptoms may include: headache, fatigue, memory loss, unexpected weight changes, sleep problems, joint and muscle pain, skin rash and digestive problems.

Interestingly it is thought that a substantial number of MUPS do have clearly-identified background factors. This can be repeated psychological traumas (especially in childhood) and is seen commonly in people who have been through terrorist attacks or wars. It is estimated that about 10% of the population have MUPS and there is some evidence to show that this can be due to immune dysfunction.  Some of these patients reveal none of the expected psychological distress and this is due to severe dissociation where chronic physical symptoms are the only means of a patient expressing overwhelming emotional pain.

Managing this group of patients in General Practice is challenging for a GP. It is vital that the patient feels understood, that the GP gives the time to broaden the approach to managing the patient by exploring the symptoms holistically looking at both psychological and social factors as well as biological.

Integrated care tailored to the patient will help them learn to deal with the problems and improve their symptoms. This may need to take a combined approach using medication such as anti-depressants, commonly used for its pain relieving properties, as well as cognitive behavioural approaches and relaxation such as hypnotherapy.

An article in the British Medical Journal (BMJ) from Dr. Mayou reported back in 1991 that systematic management of persistent unexplained medical symptoms had been neglected and that there needed to be greater collaboration in developing effective treatments, and much could be achieved by GPs with the right approach saving much unnecessary investigation and ineffective and unsatisfying consultations. A study in the BMJ in 2012 has subsequently shown statistically significant evidence that CBT can help MUS. Recent research in the BMJ open on-line journal described a study where a GP- run Symptoms Clinic showed the potential to provide clinically meaningful benefit. A questionnaire called the PHQ-15 was used as a tool for assessment before and after being seen in the clinic and there was evidence of an improvement in score in all patients. It is known that repeated referral to hospital for specialist consultation does not improve patient outcome.

Please look at www.neurosymptoms.org if you are a patient with the above symptoms and/or contact me for an appointment if you feel you would benefit from this approach.

Comments

  1. Hi Kate,
    We met on the CBT Hypnotherapy Course and I was keen to meet up with you in Bucks.
    Thanks for this impressive summary of Medically Uninterpreted Symptoms – my term – although you offer an empowering explanation and treatment that makes sense.
    I would love to catch up with you to share ideas on causation and treatment.
    I am preparing a review for the College of Medicine and am revisiting those who have a special interest and would like to share and publicise effective approaches that could be applied within general practice.
    Might we meet up – and which is your best day?

    Good Wishes,

    David

  2. Way cool! Some extremely valid points! I appreciate you writing this article and the rest of the site is extremely good.

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