Medically unexplained symptoms (MUS) are physical symptoms without an obvious or known physical cause. 1 in 4 people who see their GP have MUS, which means that for a large proportion of people, the cause of their symptoms cannot be determined. Even after 3 months of assessment and investigation, 50% of patients still have no clear diagnosis. These patients often feel frustrated and disheartened as they are left without a known cause of their symptoms. In particular, those most affected are young females who have previously experienced either depression, anxiety or a physical illness. This group of people have often been recently affected by the illness or death of a relative.

Symptoms that occur together regularly can be termed ‘medically unexplained syndromes’, which are recognisable illnesses. Examples of medically unexplained syndromes are; chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia.

Is ‘MUS’ an acceptable term?

Marks and Hunter (2015) asked patients which terms they felt were appropriate to describe symptoms which didn’t have a known cause. There was a divide amongst patients about which term they felt was appropriate. 20% chose ‘Persistent Physical Symptoms’ whereas 15% chose ‘Medically Unexplained Symptoms’.

Those with multiple MUS are often given the label of ‘somatisation disorder’. Somatisation refers to psychological distress presenting itself through physical symptoms in the body. This puts the focus on mental distress rather than acknowledging that these physical symptoms are real. Patients often feel as though this term undermines their symptoms and causes further hopelessness for finding a physical cause.

So if there is no physical cause, why are these patients experiencing physical symptoms?

Mental health problems and stress can be expressed through physical symptoms, and they can even make existing physical symptoms worse. We may be able to understand some of our physical symptoms by exploring our feelings and any stressors in our life. There is an important link between the mind and body.

For example, stressful life events or even stressful daily occurrences can cause our bodies to react in certain ways. You may experience heart palpitations, headache and muscle tension, dizziness or shakiness. It is natural to worry about these symptoms, however worry can increase the severity of the stress and physical symptoms we experience.

This link between the mind and body is interchangeable. Ongoing physical pain can sometimes lead to stress and depression, which in turn can make the pain feel worse.

Is there any treatment for those with MUS?

• Medication – antidepressants are useful in the treatment of some MUS. They help improve the patient’s anxiety around their symptoms and also decrease the severity of pain.
• Cognitive behavioural therapy (CBT) – relaxation training and psychoeducation are components which aim to inform the patient about their symptoms and how they may be worsened by psychological distress. The patient will develop coping skills to allow them to live their lives with maximum comfort and minimum distress.
• Mindfulness and meditation – research shows that patients who had six sessions of a meditation and relaxation programme experienced immediate relief from IBS symptoms.
• Group therapy – patients often experience an increase in physical functioning and mental health after group therapy sessions.

How MUS should NOT be dealt with

It is not acceptable to tell patients that their symptoms ‘are all in their head’ – their symptoms exist and the physical pain they feel is real. Do not deny the reality of the patient’s symptoms, they should not be made to feel overlooked and belittled. Patients often feel blamed for their own distress. They may feel as though their physical symptoms are being dismissed or that their GP does not accept the reality of their symptoms. 

It is important not to instantly dismiss a physical cause and jump straight to an explanation based on psychological distress. However, it is equally important not to give medication or numerous tests/scans unless it is necessary.

Iatrogenesis is the harm caused by healthcare or medication, which includes having too much unnecessary treatment. Harm includes experiencing the adverse effects of medication or experiencing depression as a result of ongoing treatment.

It is important to find a balance between exploring physical and psychological causes.

What happens if a cause is never found?

Even if an explanation cannot be found for the symptoms you are experiencing, do not lose hope. Strategies can be found to help you cope with the daily challenges you face. You can access support from a wide range of sources in order to help you adapt to and work around the symptoms you are experiencing. You can find from support from:

• Your GP
• A mental health specialist
• Mental health services such as MIND, CAMHS and Healthy Minds
• Support groups in your local community – https://www.selfhelpservices.org.uk/groups/

To conclude

Those who have physical symptoms without a known medical cause often experience a great deal of distress and frustration. These symptoms are real and it can be very undermining if told otherwise. Stress and mental health difficulties can intensify these symptoms and therefore both physical and psychological factors need to be explored in order to identify treatment options. There is a wide support network out there for you, and it is okay to reach out for help should you need it.