NHS England MUS page updated June 2021

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Possible causes of medically unexplained 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:

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.
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Self-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 (read about exercise for depression). 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 IBS. Learn about breathing exercises for stress.

Generally, planning some pleasurable personal time to unwind should help – whatever helps you relax, whether it's yoga classes, swimming, running, meditation or walking in the countryside.
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https://www.nhs.uk/conditions/medically-unexplained-symptoms/

should this page not now say " ME/CFS" and link to the new NICE guideline and specify that if diagnosed with ME/CFS (or ME/CFS is suspected) people should seek advice on ME/CFS 'treatment'.
 
from the nhs page, my bolding
You should tell the GP:

  • what your symptoms are like, when they started and what makes them better or worse
  • what you think 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
Click to expand...
That is rather sly. Based on the fact that a dx of somatisation/bodily distress disorder etc is dependant on being (in the Dr's opinion) overly distressed or emotionally affected by your symptoms, it seems rather underhand to make a point of advising people to tell their dr how it makes them feel, when they may not have done otherwise.

These days i advise anyone visiting a Dr never ever to say a symptom is upsetting them unless they want a mental health dx on top of or instead of anything else. Especially if you're female.

And as for telling the doc what you think the cause is & what you're expecting.... good grief! dont ever tell em that... thats a lightning fast route to a health anxiety/SSD dx.

ETA: I'd be very interested to know if the nhs advises anyone with any other condition to discuss their feelings about their symptoms and what they think the cause is? Since belief in an organic cause & being distressed by symptoms are what Drs are told to look out for when making a dx, this advice is leading people to do/say things that will increase their likelihood of getting a functional/conversion/BDD/SSD dx. I think it's sneaky. eewww
 
The very first line of this page, I would argue, is misleading:

Many people have persistent physical complaints, such as dizziness or pain, that don't appear to be symptoms of a medical condition.

They 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.
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The best we can say is that ‘many people have persistent physical complaints that are not currently identified as symptoms of a medical condition, for some an underlying condition may subsequently be identified, but for others, given the limits of our current medical knowledge no underlying condition will be identified’. However use of ‘medically unexplained symptoms’ sets the patient up for being gaslighted into believing they have the condition ‘Medically Unexplained Symptoms’.

Personally I would further argue that this page should give information about the problematic aspects of such a diagnosis. Here is my rewrite:

Used properly “medical unexplained symptoms” is a statement of the current limits of medical knowledge, however for some doctors/psychiatrists it is a quasi psychiatric diagnosis where, without evidence, the person making the diagnosis is asserting a belief that your symptoms arise from whichever psychological cause they happen to prefer, be it stress, personality disorder, conversion disorder, etc.

It is theoretically possible that for some people with MUS their symptoms may arise from psychological or psychiatric cause(s), but at present there are no independently verified assessments to demonstrate this, and given the advocates of MUS as a psychiatric condition often believe that actually doing medical tests will encourage suffers in false beliefs about a physiological basis for their symptoms, this diagnosis risks you will not receive adequate medical assessment and increases the the chances that a treatable medical condition, such as some heart conditions in women, will be missed.

Edited for clarity
 
Last edited:
"MEDICALLY UNEXPLAINED SYMPTOMS (MUS) IN CHILDREN AND YOUNG PEOPLE
A GUIDE to assessing and managing patients under the age of 18 who are referred to secondary care"
https://paedmhassoc.files.wordpress.com/2018/12/mus-guide-with-leaflet-nov-2018.pdf

some very disturbing practices in this document

I found the link in the download of this:

"Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in children – guidance
This guidance, published in March 2021, provides best practice advice for paediatricians in the medical management of PP and FII cases to obtain better outcomes for children."

https://childprotection.rcpch.ac.uk/resources/perplexing-presentations-and-fii/

In it they on the one hand say that PP or FII should not be confused with MUS. Then they provide a definition of MUS:
Definitions
3.2.1 Medically Unexplained Symptoms (MUS)
In Medically Unexplained Symptoms (MUS), a child’s symptoms, of which the child complains and which are presumed to be genuinely experienced, are not fully explained by any known pathology. The symptoms are likely based on underlying factors in the child (usually of a psychosocial nature) and this is acknowledged by both clinicians and parents. MUS can also be described as ‘functional disorders’ and are abnormal bodily sensations which cause pain and disability by affecting the normal functioning of the body. The health professionals and parents work collaboratively to achieve evidence-based therapeutic work in the best interests of the child or young person. In 2018, the Royal College of Psychiatrists and the Paediatric Mental Health Association (PMHA) developed a guide to assessing and managing medically unexplained symptoms (MUS) in children and young people14 and a recent editorial is very helpful15. Experienced clinicians report that, on occasion, MUS may also include PP or FII.
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which ends in the sentence "Experienced clinicians report that, on occasion, MUS may also include PP or FII."

https://childprotection.rcpch.ac.uk/resources/perplexing-presentations-and-fii/
 
JemPD said:
from the nhs page, my bolding
That is rather sly. Based on the fact that a dx of somatisation/bodily distress disorder etc is dependant on being (in the Dr's opinion) overly distressed or emotionally affected by your symptoms, it seems rather underhand to make a point of advising people to tell their dr how it makes them feel, when they may not have done otherwise.

These days i advise anyone visiting a Dr never ever to say a symptom is upsetting them unless they want a mental health dx on top of or instead of anything else. Especially if you're female.

And as for telling the doc what you think the cause is & what you're expecting.... good grief! dont ever tell em that... thats a lightning fast route to a health anxiety/SSD dx.

ETA: I'd be very interested to know if the nhs advises anyone with any other condition to discuss their feelings about their symptoms and what they think the cause is? Since belief in an organic cause & being distressed by symptoms are what Drs are told to look out for when making a dx, this advice is leading people to do/say things that will increase their likelihood of getting a functional/conversion/BDD/SSD dx. I think it's sneaky. eewww
Click to expand...

Totally agree. IME, doctors don't want to see any negative emotions. Following that NHS guidance to reveal one's feelings could lead to a mental illness diagnosis, and possibly to ignoring further testing, and investigations of one's symptoms as physiological.
 
all this to protect doctors ego's .why is it so damned hard for them to say we do not know the hard work/medical research just hasn't been done . i always wonder why the medical profession is so silent when it comes to lobbying for real research into increasing our present understanding of the extremely complex organism that is the human body .
 
Three Chord Monty said:
Related:

https://www2.hse.ie/conditions/medically-unexplained-symptoms/
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How insightful:
Causes of medically unexplained symptoms
Many people with medically unexplained symptoms, such as tiredness or pain, 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) – also known as ME
  • irritable bowel syndrome (IBS)
  • fibromyalgia (pain all over the body)
Your GP may not find a condition that causes your symptoms. This is not unusual. It does not mean that they can do nothing to help you.
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And here is me thinking if you know what causes MUS it is not ‘medically unexplained’. Pure conjecture and innuendo, without any real evidence.
 
alktipping said:
i always wonder why the medical profession is so silent when it comes to lobbying for real research into increasing our present understanding of the extremely complex organism that is the human body .
Click to expand...
because that would be to rub salt in the unface-able wound that is the fact that everything there is to know is not yet known. Its too distressing for them, they cant go into their working day feeling as if they (collectively) dont know everything, it would be too scary.

with many lives in their hands there has to be a degree of hubris, otherwise how do they trust their own judgement. The uncertainty would be devastating i'd think. Or at least take a very mature & courageous mindset, and many of the Drs i have seen, both personally and witnessed, are really rather childish in their mindset & behaviour. they just cant handle it.


Its quite sad if it werent so catastrophically bad for their patients who fall into the 'dont yet know' category. Those patients shine a spotlight on their inadequacy - they cant allow that to stand, so....
 
given the recent discussions re mus I've had another look at this page.

it specifies
Common medically unexplained symptoms

Common medically unexplained symptoms include:

  • pains in the muscles or joints
  • back pain
  • headaches
  • tiredness
  • feeling faint
  • chest pain
  • heart palpitations
  • stomach problems
About 1 in 4 people who see a GP have physical symptoms that cannot be explained.
Click to expand...
Possible causes of medically unexplained 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:

Click to expand...

so the NICE guidelines for ME/CFS including diagnostic criteria are what? some attempt to explain a 'poorly understood syndrome'? o_O
 
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