Treating medically unexplained symptoms

Several studies suggest ways to deal with patients who have pain and discomfort even when a treatable disease cannot be found.

By Victoria Stagg Elliott, AMNews staff. Sept. 18, 2006.

Cognitive behavioral therapy, psychotropic medications and an empathic relationship with a physician can reduce patients' medically unexplained symptoms, such as backaches, dizziness, headaches or fatigue, according to a pair of studies published this summer.

One study, published in the July 24 Archives of Internal Medicine, found that cognitive behavioral therapy performed by a mental health professional reduced the physical symptoms of patients with somatization syndrome. It also improved functioning and reduced the utilization of health care services.

The other, appearing in the July Journal of General Internal Medicine, found that patients with medically unexplained symptoms could be treated in the primary care setting.

Researchers randomized patients who had a history of high health care utilization to receive either usual care or cognitive behavioral therapy and treatment by physicians trained in patient-centered care.

"Virtually all treatment studies of medically unexplained symptoms are by mental health providers," said Robert C. Smith, MD, the lead author of that paper and professor of general internal medicine and psychiatry at Michigan State University in East Lansing. "This was the first comprehensive treatment by primary care [physicians and nurses] in a randomized controlled trial."

In this study, the focus of care was improving a patient's ability to cope rather than eliminating his or her symptoms. Many patients were prescribed antidepressants, and all were assured that they did not have a serious disease. Instead, they were told they had a problem that required attention. This intervention resulted in patients feeling better.