Medically unexplained symptoms: evidence, guidelines, and beyond

Abstract

Medically unexplained symptoms (MUS) are frequently presented in primary care.1 In about 25–50% of all symptoms presented in primary health care, no support for an underlying physical disease can be found. MUS are a heterogeneous group of symptoms and can involve almost all types of symptoms that patients present to their GP. Functional somatic syndromes, such as irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome (CFS), as well as symptoms stemming from a specific somatic disease that are more severe, more persistent, or limit functioning to a greater extent than expected, based on (objective) disease parameters, are also referred to as MUS. MUS represent a spectrum of severity from mild via moderate to severe, characterised by an increased number and duration of symptoms and functional limitations. Most of the time MUS are transient and self-limiting, but sometimes MUS persist, resulting in extensive investigations and referrals and unnecessary healthcare costs. Therefore, early recognition of MUS is of paramount importance. Although only 2.5% of the patients in general practice meet criteria for persistent or severe MUS (such multiple symptoms that persist for longer than 3 months resulting in severe functional limitations), GPs experience many difficulties in caring for these patients.2 For that reason the Dutch College of General Practitioners decided to publish the evidence-based primary care guideline on MUS, which provides …