Functional Somatic Symptoms, 2019, Roenneburg et al

[Andy]

Background: Approximately 10% of the general population and around one third of adult patients in clinical populations suffer from functional somatic symptoms. These take many forms, are often chronic, impair everyday functioning as well as quality of life, and are cost intensive.

Methods: The guideline group (32 medical and psychological professional societies, two patients’ associations) carried out a systematic survey of the literature and analyzed 3795 original articles and 3345 reviews. The aim was to formulate empirically based recommendations that were practical and user friendly.

Results: Because of the variation in course and symptom severity, three stages of treatment are distinguished. In early contacts, the focus is on basic investigations, reassurance, and advice. For persistent burdensome symptoms, an extended, simultaneous and equitable diagnostic work-up of physical and psychosocial factors is recommended, together with a focus on information and self-help. In the presence of severe and disabling symptoms, multimodal treatment includes further elements such as (body) psychotherapeutic and social medicine measures. Whatever the medical specialty, level of care, or clinical picture, an empathetic professional attitude, reflective communication, information, a cautious, restrained approach to diagnosis, good interdisciplinary cooperation, and above all active interventions for self-efficacy are usually more effective than passive, organ-focused treatments.

Conclusion: The cornerstones of diagnosis and treatment are biopsychosocial explanatory models, communication, self-efficacy, and interdisciplinary mangagement. This enables safe and efficient patient care from the initial presentation onwards, even in cases where the symptoms cannot yet be traced back to specific causes.

Open access, https://www.aerzteblatt.de/int/archive/article?id=209399

 

[Mithriel]

The patient is given CBT and when that does not work the medical system washes their hands of them because they do not want to get better and there is nothing more medicine can do for them; the patient knows what to do and it is up to them to do the work.

 

[Sean]

analyzed 3795 original articles and 3345 reviews.

Nah, you didn't.

Results: Because of the variation in course and symptom severity, three stages of treatment are distinguished. In early contacts, the focus is on basic investigations, reassurance, and advice. For persistent burdensome symptoms, an extended, simultaneous and equitable diagnostic work-up of physical and psychosocial factors is recommended, together with a focus on information and self-help. In the presence of severe and disabling symptoms, multimodal treatment includes further elements such as (body) psychotherapeutic and social medicine measures. Whatever the medical specialty, level of care, or clinical picture, an empathetic professional attitude, reflective communication, information, a cautious, restrained approach to diagnosis, good interdisciplinary cooperation, and above all active interventions for self-efficacy are usually more effective than passive, organ-focused treatments.

Conclusion: The cornerstones of diagnosis and treatment are biopsychosocial explanatory models, communication, self-efficacy, and interdisciplinary management. This enables safe and efficient patient care from the initial presentation onwards, even in cases where the symptoms cannot yet be traced back to specific causes.

Written like an ad for washing powder.

And just as meaningless.

 

[Trish]

active interventions for self-efficacy are usually more effective than passive, organ-focused treatments.

What on earth is that supposed to mean?
It seems to imply that therapy (active) is more effective than drugs (passive). Tell that to the authors when they get cancer.

 

[Hoopoe]

A diagram from the article.



Very similar to the model in PACE which didn't produce any meaningful effects.

Just because someone can fantasize that it is so does not mean it actually is, but maybe that's a difficult concept to understand for the psychosomatic medicine crowd.

I'm also curious how well this model would fit an average patient with a disease considered to be entirely "organic". I think that average patient would have "secondary gains" from the illness if one wanted to find them, they would probably have lost some fitness, they might have sequelae of prior treatments, they could easily have "avoidant" behaviour of some kind, they certainly have precedent life stressors, they may well have prior organic disease, they are probably worried and anxious, they might be depressed or have particular cultural beliefs or an unpleasant childhood. And of course, they would have "fixed disease conviction" and the perception that something is wrong.

 

[Arnie Pye]

When I read about the health service creaking under the strain of an increasing number of patients, I wonder how much of that is due to people rarely being cured of anything. So as time goes by and the patients get older the number of physical problems they have just increases and increases. They get put on more and more medication, which have interactions and side effects for which they are given more pills. It's no surprise that people are getting sicker and sicker and the health service gets more and more expensive. (Although I wonder how many of the complaints about cost are for political purposes, not the real truth.)

 

[Trish]

When I read about the health service creaking under the strain of an increasing number of patients, I wonder how much of that is due to people rarely being cured of anything.

It's creaking under the strain of being underfunded and understaffed.

 

[Arnie Pye]

It's creaking under the strain of being underfunded and understaffed.

Yes, I agree - but I also think chronic under-diagnosis is making a huge problem even worse.

 

[chrisb]

Never mind. The music therapy will sort it. Sounds like they have already made a start with the "organ-focused treatments".

 

[rvallee]

The whole thing could be replaced by a link to goop.com. Exactly equivalent. Anyone who actually thinks there is such a thing as "secondary benefits" of illness, real or fake makes no difference, is out of their damn mind. Incredible display of false attribution error. Not exactly surprising considering there is no feedback system and medicine is entirely supply-side, does not consider demand or need.

This stuff is to medicine what astrology is to astronomy. I don't think there's ever been a more blatant example of an entire field of science regressing so badly.

This enables safe and efficient patient care

Safe for physicians, it does not affect them. Efficient for budgets, as doing nothing useful can be cheap. For patients? It does not. It's a complete and total disaster. We are proof of it, a disease strictly treated under a psychosocial model with catastrophically bad results, zero progress in 3 decades and independently and self-consistent complaints about the failure that are simply ignored because this is a strict one-way approach that dismisses everything the patient and instead fabricates a bullshit "rousingly reassuring" explanation that has the same relation to reality as Game of Thrones.