Abstract
Functional somatic syndromes (FSS) are characterised by the presence of one or multiple chronic symptoms that cannot be attributed to a known somatic disease. They are thought to arise though a complex interaction of biological and psychosocial factors, but it is unclear whether they share a common aetiology. One hypothesis supported by recent studies is that the FSS are postinfectious disorders, as is widely recognised for a subset of patients with irritable bowel syndrome. Our study used claims data submitted by office-based physicians to compare groups of patients with different FSS in the five years before and after the point of first diagnosis. Even five years prior to diagnosis, FSS patients consulted more frequently for a range of psychological and somatic conditions than did controls. Following diagnosis, consultation rates increased further and remained persistently high. Five years after diagnosis, between 34% (somatization disorder) and 66% (fibromyalgia) of patients were still being treated for the condition. Both prior gastrointestinal and upper-respiratory infection were associated with an increased risk of developing an FSS. We therefore recommend that patients at risk should be identified at an early stage and the underlying psychosocial and somatic issues addressed to prevent progression of the condition.
Highlights
Several possibly interacting mechanisms have been proposed to explain why some people develop chronic functional conditions
The subgroups ranged in size from 20,185 patients (Chronic Fatigue Syndrome) to 720 patients (Fibromyalgia Syndrome). 898 patients were coded with two different Functional somatic syndromes (FSS) diagnoses in the same initial quarter and were included in a “multiple FSS” group
Our study demonstrates the importance of the bio-psychosocial model both for an understanding of aetiology and for clinical practice
Summary
Several possibly interacting mechanisms have been proposed to explain why some people develop chronic functional conditions. Little evidence exists as to whether this association holds for other functional syndromes such as tension headache or fibromyalgia Such a global effect is conceivable, as gastrointestinal infection may lead, for example, to a disturbance of the gut-brain axis, to autoimmune reactions, or to dysbiosis of the microbiome. Both functional and postinfectious syndromes are generally viewed within a bio-psychosocial framework, with the propensity to suffer long-term distress associated with certain psychological traits[16,17,18]. It is unclear why, for example, one patient might present with postinfectious IBS and another with postinfectious CFS
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