By Dr. Zulfikar Bux
Assistant Professor of Emergency Medicine
Many people have persistent complaints, such as dizziness or pain, that don’t appear to be symptoms of a medical condition. It’s a puzzling time for us as doctors when we can’t figure out the cause of the symptom(s).
These symptoms are sometimes known as “medically unexplained symptoms” when they last for more than a few weeks, but doctors can’t find a problem with the body that may be the cause. This doesn’t mean the symptoms are faked or being made up. They’re often real and can affect your ability to function properly. Not understanding the cause can make them even more distressing and difficult to cope with.
Today we will talk about how best to address symptoms that cannot be explained medically.
WHAT ARE SOME CAUSES OF UNEXPLAINED MEDICAL SYMPTOMS?
Many people with medically unexplained symptoms, such as tiredness, pain and heart palpitations, also have depression or anxiety. Treating an associated psychological problem can often relieve the physical symptoms. For others, the symptoms may be part of a poorly understood syndrome, such as:
• chronic fatigue syndrome (CFS)
• irritable bowel syndrome (IBS)
• fibromyalgia (pain all over the body)
When mystery symptoms seem to be caused by problems in the nervous system but you don’t have a specific nervous system condition, your doctor may refer to your symptoms as a ‘functional neurological disorder’.
Examples of such symptoms include:
• tingling in the hands or feet
• a tremor in one or both arms
• headaches or migraines
• changes in eyesight, like blurred vision or seeing flashing lights
The fact that doctors are unable to find a condition causing these symptoms isn’t unusual in medicine, and it doesn’t mean that nothing can be done to help you.
WHAT CAN YOUR DOCTOR DO TO HELP?
Your doctor will aim to rule out all the possible conditions that might be causing your symptoms. You may have go through thorough questioning, physical examination and blood tests. It’s important to consider whether any medication you’re taking may be causing your symptoms – for example, taking painkillers long term can lead to painkiller headaches. Your doctor should also investigate whether you might have an associated problem, such as depression or anxiety. Physical symptoms can cause depression and anxiety, and these can in turn make the physical symptoms worse, creating a vicious circle.
WHAT SHOULD YOU TELL YOUR DOCTOR TO HELP?
The following are questions that your doctor may want to have answered:
• What your symptoms are like – when they started and what makes them better or worse?
• What you think or fear is the cause of your symptoms – and your expectations of how tests and treatments might help?
• How your symptoms affect what you can do – what they stop you doing?
• How upsetting your symptoms are – how they make you feel
ARE THERE TREATMENT OPTIONS?
You and your doctor may identify some lifestyle changes and goals that you both think will help relieve your symptoms, such as regular physical activity and better rest. You may be referred for a talking therapy, such as cognitive behavioral therapy (CBT). The aim of CBT is to help you to manage your symptoms by enabling you to understand links between your symptoms, worries, feelings and how you cope.
If your symptoms seem to be caused by a problem with the nervous system, you may be referred to a neurologist (a specialist in disorders of the nervous system).
Medication such as antidepressants can be helpful, even if you’re not depressed. However, medication isn’t always the answer – painkillers or sedatives, for example, may lead to you becoming dependent on them. The possible benefits of medication always need to be weighed against the potential side effects.
If you think you have an underlying condition that’s been missed by your doctor, you can always ask for a second opinion.
ARE THERE THINGS YOU CAN DO BY YOURSELF TO HELP?
There are things you can do to improve or even relieve some physical symptoms, such as taking regular exercise and managing stress. Regular exercise will help keep you fit and many people find that it also boosts their mood. How much exercise you should do will depend on your current health and capabilities. Managing stress is very important because it’s been linked to problems such as pain and abnormal bowel movements. Planning some pleasurable personal time to unwind should help. Do whatever you can to help you relax, whether it’s yoga classes, swimming, praying, running, meditation or walking.
As doctors, we do not know everything and there are conditions that are beyond our comprehension. Having a symptom that cannot be medically explained is not the end of the world. Using the coping mechanisms that we describe today may help to relieve your symptoms. If you have a medically unexplained symptom, just know that your body has a remarkable ability to recover and there’s a good chance that your symptoms will improve in time, even without any specific treatment.
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