All in the Mind?

Article excerpt

Doctors call them heart-sink cases: the one in four patients whose symptoms have no known cause. So are they really ill? Roger Dobson investigates

Most patients expect a quick diagnosis and cure from their doctor. But what if nothing can be found? What if there is no medical explanation for the symptoms, let alone a cure? More than one in four patients visiting their GP have unexplained pain or symptoms, according to a new report. Other research suggests that up to 50 per cent of primary-care users have symptoms that cannot be tracked down.

And it is not just chronic aches and pains. Sensory loss, walking problems, hallucinations, non-cardiac chest pain, paralysis and seizures are all there, with no apparent cause. Some patients have a history of eight or more unexplained complaints in different parts of their body.

"Medically unexplained symptoms can be related to any body system and most medical specialties. Common symptoms include fatigue, dizziness and pain, although sexual and reproductive problems and abdominal pain, bloating, diarrhoea and constipation are also common,'' says Richard Brown, a psychologist at Manchester University.

According to a new British Medical Journal report, these "heart- sink patients" - a name based on the doctor's reaction to seeing them in the surgery - are a considerable problem. "More than a quarter of primary-care patients in England have unexplained chronic pain, irritable bowel syndrome or chronic fatigue," it says. "And around a third of new neurological outpatients have symptoms thought by neurologists to be not at all or only somewhat explained by disease.''

Medically unexplained symptoms (MUS) are those that cannot be explained by specific illness or injury. Common conditions associated with MUS include irritable bowel syndrome, non-epileptic attack disorder, chronic fatigue syndrome, multiple chemical sensitivity, hyperventilation syndrome and Gulf War Syndrome. For the patient, the symptoms are as disabling as those for which a cause is found. Some patients can suffer for years with chronic pain, while others are bed-ridden.

The reasons why some people have unexplained symptoms are not clear. According to the American Academy of Family Physicians, some may be more sensitive to changes in the way the body works, and are more quick to pick up on functional changes. Stress can also make this sensitivity stronger, and depression and anxiety are common in people with MUS. One study found that almost half of patients with unexplained movement problems had an undiagnosed psychiatric problem, while an Israeli study shows that common additional diagnoses are anxiety, depression, sexual dysfunction and marital problems.

Stress is also a factor in unexplained chest pain, a common reason for costly emergency hospital admission. …