Medically unexplained symptoms

Physical symptoms are not always associated with disease. In secondary medical care as many as a third of patients present with symptoms unexplained by disease. Such ‘medically unexplained symptoms’ pose a challenge for clinical services that focus on identifying and treating disease. The principles of effective management are to: (a) avoid overinvestigation and giving speculative treatment for disease; (b) take a positive approach with the patient, accepting the reality of the symptoms while explaining clearly that they do not indicate disease; (c) identify and provide treatment for associated depression and anxiety disorders; (d) refer for psychiatric or psychological treatment when required. Complex cases with multiple persistent medically unexplained symptoms are at particular risk of iatrogenic harm and require active multidisciplinary management. Psychological treatments such as cognitive behaviour therapy may be effective.