Medically unexplained symptoms (MUS) are physical symptoms that have no currently known physical pathological cause. They constitute a clinically, conceptually and emotionally difficult area to tackle, with clinical presentations varying greatly, from people who regularly attend GP surgeries with minor symptoms to people who may be bed-bound.
MUS are common, accounting for as many as one in five new consultations in primary care. The unexplained symptoms can cause significant distress to the patient and, in some circumstances, impair functioning.
The vast majority of MUS, such as pain or irritable bowel syndrome, have no obvious cause and often do not actually require any input from health services. However, studies have shown that between 20% and 30% of consultations in primary care are with people who are experiencing MUS and have no clear diagnosis. It is estimated that this rises to an average of 52% in secondary care where a substantial proportion of secondary care resources are used by those using services but whose symptoms remain unexplained.
People suffering with MUS are sometimes described by health professionals as somatisers, but this term is often very unpopular with patients as it implies the MUS are related to a psychiatric disorder, which may or may not be present. However, up to 70% of people suffering with MUS will also suffer from depression and/or anxiety disorders. This is of significance because these mental health disorders are detectable and treatable, irrespective of the explanation for the physical symptoms.
Addressing the issue
Medically Unexplained symptoms (MUS) commonly present in primary care and result in a considerable use of health resources. There is randomised controlled trial evidence that improving access to psychological therapies for people with such symptoms may improve function and reduce health expenditure.
Along with the Pathfinder site, Stoke PCT, the IAPT MUS Special Interest Group has been exploring:
- Benefits
- Recognition and treatment strategies
- Economic issues
relating to delivering psychological therapies to people with medically unexplained symptoms. The Group has produced a short Positive Practice Guide available at http://www.iapt.nhs.uk/services/positive-practice-guides/
The Nottingham Tool
Nottingham Medical School has developed a tool that identifies patients who are likely to have medically unexplained symptoms. The Nottingham Tool searches a GP Practice Database, to identify a cohort of patients that fulfil the criteria for medically unexplained symptoms. This cohort provides an overview to the commissioners, or the practice, about the number of people likely to have a medically unexplained symptom. Read more and download the tool.
Plymouth Project Report
Medically unexplained symptoms (MUS) are common, associated with significant distress, and can result in unnecessary and costly referrals, diagnostic tests and even operative procedures. The current system for treating MUS is inefficient; resulting in unnecessary stress and dissatisfaction for both clinicians and patients in addition to the use of a disproportionate amount of time and resources. This project report outlines the systemic approach to developing treatment solutions.
It develops guidance for the management of MUS by GPs and specialists, suggests a commissioner led approach to MUS and highlights the findings of piloting the development of ‘care pathways' for MUS in Plymouth.
Download the Plymouth MUS Report here.