Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach [..] recovery, 2026, Abrahamsen+

[forestglip]

Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach to promote recovery

Spoiler: Authors

Abrahamsen, Cathrine; Beadsworth, Mike; Bostock, Will; Chalder, Trudie; Flottorp, Signe; Fors, Egil A.; Garner, Paul; Hadfield, Sarah; Kennedy, Becca; Kuehn, Rebecca; Landmark, Live; Launes, Gunvor; Liira, Helena; Linnestad, Lina; Rotkirch Virrantaus, Hélène; Vangelova-Korpinen, Velina

Background
A substantial proportion of people consulting primary care practitioners have symptoms that persist even after structural problems and diseases have been excluded. They experience distressing somatic complaints – such as fatigue, pain, headaches, and brain fog – lasting months or longer which impair quality of life and workability. In this article, we refer to these as persistent physical symptoms (PPS). When diagnosis, advice and care are based solely on a biomedical interpretation of symptoms, patients may not improve. This can result in repeated and often frustrating consultations and investigations.

Aim
To outline contemporary theories around PPS for general practitioners, and offer practical, evidence-informed pathways to use in primary care.

Methods
Narrative literature review and consensus development with experienced practitioners.

Synopsis
Contemporary theories Contemporary theories of PPS provide a coherent framework for understanding symptom persistence and guide treatment. These theories propose that symptoms may arise from brain-based responses to perceived threat, influenced by expectations and learned associations. Such responses can become unhelpful when benign sensations are interpreted as dangerous. Biopsychosocial factors unique to each individual influence these mechanisms which need to be considered when assessing PPS and working towards symptom resolution with the patient.

Evidence-informed pathways
Key strategies include validating patients’ symptoms and emotional experiences, providing clear explanations of symptom persistence, and developing personalised management plans that combine biological, psychological, and social approaches. Such strategies can reduce or resolve symptoms, foster hope and a sense of agency, and often lead to recovery.

Web | DOI | PDF | Scandinavian Journal of Primary Health Care | Open Access

 

[forestglip]

PPS include fatigue, exhaustion, pain, and sometimes digestive or specific functional neurological problems. Current diagnostic classifications do not correspond well with the contemporary scientific understanding of PPS, and this causes confusion. Groups of persistent symptoms may be labelled as conditions, and include myalgic encephalomyelitis/chronic fatigue syndrome, post-viral fatigue syndrome, post COVID-19 condition, fibromyalgia, irritable bowel syndrome, functional neurological disorders or environmental sensitivity. However, symptoms within these labels overlap and may evolve from one symptom profile to another over time [1,5-7]. A common element across all is the understanding that biological, psychological, and social factors influence these conditions.

 

[NelliePledge]

Ugh

 

[Jonathan Edwards]

It seems as if evidence-informed may be replacing evidence-based?

Why are there about thirty authors when a review paper like this can be written by one person?

 

[MrMagoo]

I feel like we need a “rage” scale as to how enraging the “average” forum member is likely to become from reading any given paper.

Whatever the top rating is, this qualifies.

 

[Jonathan Edwards]

A substantial proportion of people writing in primary care practitioner journals have symptoms that persist even after structural problems and diseases have been excluded. They experience distressing somatic complaints – such as encountering people with fatigue, pain, headaches, and brain fog – lasting months or longer which impair quality of life and work satisfaction. In this article, we refer to these symptoms as persistent biopsychosocial symptoms (PBS). When diagnosis, advice and care are based solely on a biomedical interpretation of these symptoms, authors may not improve. This can result in repeated and often frustrating discussions on patient forums.

 

[Joan Crawford]

"Contemporary theories of PPS provide a coherent framework for understanding symptom persistence and guide treatment. These theories propose that symptoms may arise from brain-based responses to perceived threat, influenced by expectations and learned associations."

Nought contemporary about this. Freud was hard at this a century ago.....

 

[Utsikt]

It looks like they are mostly citing their own opinion pieces, sometimes disguised as narrative reviews etc., and other similar publications by BPS proponents.

They cite Abrahamsen’s own ICIT articles (they are very flawed), Nerli that found that the intervention didn’t work even though they claimed success, Ursin’s central sensitisation study, Crawley’s review of LP, and Frisk’s study with no control arm.

If this is them displaying the best studies they’ve got, they really should be embarrassed. Perhaps some guided conversations can help extinguish their unhelpful beliefs in that they are actually scientists.

Brain retraining and Recovery Norway features:

Some patients benefit from specific brain retraining programmes; the Lightning Process has been evaluated in a small trial, and several trials in other packages are currently ongoing [Citation33]. Some of these programmes offer one-to-one support from a trained practitioner as part of follow-up care.

Case reports and case series, for example as documented on Recovery Norway, suggest some dramatic results of people with severe ME/CFS – bedbound and tube fed – who improved within a short period after participating in structured brain re-training programmes. More rigorous qualitative and quantitative evaluations are needed to inform policy and provide evidence-based guidance.

And it looks like Live Landmark forgot to disclose her conflict of interest wrt her LP courses. As well as Abrahamsen (she sells educational programmes to GPs etc with ICIT),

Disclosure statement​

No potential conflict of interest was reported by the author(s).

@dave30th something to notify the editors about?

 

[Joan Crawford]

....providing clear explanations of symptom persistence,"

How's that possible if the honest answer is that no one has much of a clue.

Duplicity mascarading as medical care.

 

[dave30th]

Nought contemporary about this. Freud was hard at this a century ago

Except that "brain-based responses" or "brain network" issues have replaced "psychological trauma" or "psychological issues" as the purportive causative factor. They're just exchanging one set of words with another to make it sound more scientific, but the lack of evidence for either "psychological issues" or "brain network" issues is glaring.

 

[dave30th]

@dave30th something to notify the editors about?

Hm. I'll take a look. thanks for the heads up!!

 

[dave30th]

How's that possible if the honest answer is that no one has much of a clue.

very similar to the claims in the paper to which we responded last year (or the year before?)--that a clear explanation was helpful.