Medically unexplained symptoms and associated conditions

Question 1

Definition of medically unexplained symptoms?

Answer 1

Physical symptoms for which no organic cause can be demonstrated

Question 2

Main classification of MUS? (3)

Answer 2

Pain of a specific area (e.g. backache, headache, fibromyalgia, chronic pelvic pain)
Functional disturbance of an organ (e.g. IBS, palpitations)
Fatigue/exhaustion (e.g. chronic fatigue syndrome)

Question 3

When should a diagnosis of MUS be considered?

Answer 3

In any patient with physical symptoms for three months, which affect functioning but cannot be readily explained

Question 4

General treatment options for MUS (2)

Answer 4

Antidepressant medication e.g. amitriptyline 10mg nocte, titrate (may be unlicensed)
CBT

Question 5

Definition of somatic symptom disorder

Answer 5

Expression of psychological illness through medical symptoms

Question 6

Risk factors for medically unexplained symptoms (4)

Answer 6

Affective disorder
Anxiety
Social stressors
History of childhood abuse

Question 7

What should be considered in patients presenting with non-specific somatic symptoms?

Answer 7

Anxiety or depression

Question 8

Definition of chronic fatigue syndrome?

Answer 8

Unexplained persistent and/or recurrent fatigue of new onset, not explained by other conditions, and resulting in reduced activity

Question 9

How many months must fatigue have been present for a diagnosis of CFS to be made?

Answer 9

At least six months in adults

Question 10

Common associated symptoms in CFS (4) (if none of these are present, re-consider diagnosis)

Answer 10

Cognitive difficulties
Chronic pain
Post-exertional malaise (PEM)
Sleep disturbance

Question 11

Main component of CFS/ME management?

Answer 11

Pacing- striking balance between activity and fatigue

Question 12

Controversy with regards to CFS/ME management?

Answer 12

NICE guidelines recommend graded exercise + CBT; conflicting evidence about effectiveness of these interventions, many patients have found these detrimental, many patients find the idea of using CBT as inappropriate and offensive

Question 13

Definition of fibromyalgia

Answer 13

Chronic non-articular pain at multiple sites

Question 14

Diagnostic criteria for fibromyalgia? (2)

Answer 14

History of widespread (bilateral, above and below waist) together with axial skeleton (e.g. neck/back) pain, combined with;

Pain in 11 or more of 18 tender sites

Question 15

Non-drug management of fibromyalgia?

Answer 15

Aerobic and resistance exercise
CBT may be useful
Acupuncture

Question 16

NICE guidelines on management of chronic pain?

Answer 16

Suggest antidepressants
Avoid opiates, gabapentinoids, NSAIDs, paracetamol
Focus on non-pharmacological management

Question 17

Diagnostic criteria for IBS?

Answer 17

Abdominal pain/discomfort which is relieved by defaecation or associated with altered bowel frequency/stool form

And more than two of the following:
altered stool passage (straining, urgency, incomplete evacuation)
abdominal bloating/distension
symptoms worsened by eating
passage of mucus