Recent Developments in the Understanding and Management of Functional Somatic Symptoms in Primary Care

Per Fink; Marianne Rosendal


Curr Opin Psychiatry. 2008;21(2):182-188. 

In This Article

Abstract and Introduction

Purpose of review: Medically unexplained or functional somatic symptoms are prevalent in primary care, but general practitioners commonly find them difficult to treat. We focus on the conceptual issues and treatment from a primary care perspective, although the field is difficult to review because of the inconsistency and multiplicity of terminology used by different authors and specialties.
Recent findings: The training of general practitioners in management techniques has been hampered by an obsolete theoretical framework and outdated diagnostic systems. Epidemiological studies, however, indicate that valid, empirically based diagnostic criteria for functional disorders may be developed. Management studies in primary care have shown disappointing effects on patient outcome, but a lot may be gained by making the training programmes more sophisticated. Recently, stepped care approaches have been introduced but they need scientific evaluation.
Summary: There is an immediate need for a common language and a theoretical framework of understanding of functional symptoms and disorders across medical specialties, clinically and scientifically. Any names that presuppose a mind-body dualism (such as somatization, medically unexplained) ought to be abolished. The overall ambition for treatment is to offer patients with functional somatic symptoms the same quality of professional healthcare as we offer any other patient.

A substantial proportion of patients encountered in primary care complain of physical symptoms not attributable to any known conventionally defined disease.[1,2,3] Such functional somatic symptoms and disorders are often a burden for the sufferers, costly for society and difficult to treat. Nevertheless, functional disorders are grossly ignored in general psychiatry,[4] and most countries offer no or very limited specialized care for these patients. Hence, general practitioners (GPs) often have to manage these, at times, very ill patients.

The inconsistency and multiplicity of terminology used by different authors, specialties, and the many subcultures among researchers with regard to classification makes it difficult to review this field, and we have chosen to focus on only conceptual issues and management from a primary care perspective.


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