Medically unexplained symptoms in primary care

An estimated 15–30% of all primary care consul­ tations are for medically unexplained symptoms (Kirmayer et al, 2004). Patients with such symptoms receive large amounts of symptomatic investigation and treatment (Barsky & Borus, 1999). The number of medically unexplained symptoms over a per­ son’s lifetime correlates linearly with the number of depressive and anxiety disorders experi enced (Katon & Walker, 1998). However, numerous soma­ tic symptoms or illness worry cannot be solely explained by concurrent anxiety and depression (Creed & Barsky, 2004). The terminology in relation to these problems is unsatisfactory and stigmatising. The term ‘somatisation’ is widely used, indicating the psy­ chological process by which psychological distress is transformed into somatic symptoms. There is little evidence, however, that this process actually occurs, although psychological factors undoubtedly play a role in the development and maintenance of many physical complaints. The term ‘medically un­ explained symptoms’ is preferred by many general practitioners (GPs) and primary care researchers, as this nomenclature does not imply any sense of psychological causation. Medically unexplained syndromes such as irritable bowel syndrome, chronic pelvic pain, fibro myalgia and chronic fatigue syndrome are characterised by clusters of symptoms that Medically unexplained symptoms in primary care