Managing Medically Unexplained Symptoms in Primary Care: A Narrative Review and Treatment Recommendations

Abstract

Medically unexplained symptoms (MUS) are persistent physical symptoms in the absence of identifiable disease. MUS present a major challenge for primary care providers (PCPs) because complex symptom presentations, strained patient-physician relationships, and treatment-resistant symptoms can challenge a PCP's sense of competency. This review is intended to help PCPs understand the burden and theoretical context of MUS and to provide concise recommendations for managing MUS within primary care settings. Based on a narrative review of the literature, these recommendations emphasize in particular the importance of co-creating plausible explanations for MUS, understanding the pitfalls of consultations involving MUS, and developing multimodal treatment plans.

Keywords: behavioral health; medically unexplained symptoms; primary care.

Figure 1.

Case example of a patient with medically unexplained symptoms.

Figure 2.

Assessment and plan for hypothetical patient with medically unexplained symptoms.

Figure 3.

Kroenke’s (2006) modified stepped care approach. MUS, medically unexplained symptoms.