One Third of Symptoms
Have Mysterious Origin

More than one third of the physical symptoms that bring people to doctors' offices have no clear cause, new research suggests.

As a result, after answering questions about their symptoms and submitting to diagnostic tests, patients are often "left with what I call a 'symptom diagnosis,"' said study author Dr. Kurt Kroenke, in which the doctor says they have pain, for example, but can give no reason why.

But a lack of an underlying illness does not mean the symptom isn't real, and Kroenke urges patients and doctors alike to take all physical symptoms seriously, regardless of what diagnostic tests reveal.

"Testing can be very focused," he told Reuters Health. "And (a negative test result) by itself doesn't mean there's no symptom."

During the study, Kroenke and his colleagues reviewed the records of 289 people who visited a primary care clinic for about 433 physical symptoms.

The researchers found that physicians could pinpoint a physical cause for 52 percent of symptoms, and classified another 10 percent as resulting from a psychiatric illness. Approximately 37 percent of patients' symptoms appeared to have no known cause.

Most patients visited their doctors as a result of pain, commonly back pain, headache or pain in arms or legs. Other frequently reported symptoms included cough and trouble breathing.

And one quarter of the patients were still experiencing the same symptoms 12 months after the visit, according to the report, which appears in the journal Psychosomatics.

Men, people with headaches or back pain, and those with other medical problems were all more likely than others to feel the same symptom 12 months later.

There are certain things patients can do when their doctors cannot find a reason why they feel ill, said Kroenke, who is based at the Indiana University School of Medicine in Indianapolis.

Previous research has shown that patients who voice their concerns about a particular symptom tend to do better than patients who don't. Consequently, Kroenke recommends that patients tell their doctors if they think they need a particular test or treatment, or are afraid their symptom means they have a deadly disease, for example.

Voicing concerns enables a doctor to at least tell patients what they don't have or don't need, even if the doctor can't explain why they feel bad, Kroenke said.

At least one half of people with unexplained, persistent or multiple physical symptoms have depression or anxiety, the researchers report, and treating either disorder can sometimes alleviate physical symptoms, as well.

Kroenke noted that some patients also benefit from programs designed to help people with persistent symptoms, such as those that focus on pain management.

SOURCE: Psychosomatics, November-December 2003.

Reference Source 89

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