Persistent physical symptoms: definition, genesis, and management
- PMID: 38879263
- DOI: 10.1016/S0140-6736(24)00623-8
Persistent physical symptoms: definition, genesis, and management
Abstract
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.
Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests BL reports research funding (no personal honoraria) from the German Research Foundation, the German Federal Ministry of Education and Research, the German Innovation Committee at the Joint Federal Committee, the European Commission's Horizon 2020 Framework Programme, the European Joint Programme for Rare Diseases, the Ministry of Science, Research and Equality of the Free and Hanseatic City of Hamburg, Germany, and the Foundation Psychosomatics of Spinal Diseases. He has received remunerations for scientific book articles from Elsevier, Thieme Publishing, Clett Kotta Publishing, and Hogrefe Publishing. He has received remunerations from the Norddeutscher Rundfunk for interviews in medical knowledge programmes on public television, and as a committee member from Aarhus University, Denmark. He received travel expenses from the European Association of Psychosomatic Medicine (EAPM) and accommodation and meals from the Societatea de Medicina Biopsyhosociala, Romania, for a presentation at the EAPM Academy at the Conferința Națională de Psihosomatică in October, 2023. He was a board member of the EAPM (unpaid) until 2022. AT reports research funding (no personal honoraria) from the German Research Foundation. She has received remunerations for a printed textbook from Ernst Reinhardt Publishing. JGMR reports research funding (no personal honoraria) from the European Commission's Horizon 2020 Framework Programme, the National Institutes of Mental Health, the Netherlands Research Council, and the Netherlands Organisation for Health Research and Development. She has received honoraria from Lannoo Publishers for a book she coedited and from educational institutions for teaching psychosomatic therapists. She is a member of the advisory board and the data safety and monitoring board of the SOMACROSS research unit (FOR 5211) and the scientific board of the Lifelines cohort study and biobank (both unpaid). She is vice president of the EAPM and the Dutch Network Persistent Somatic Symptoms (both unpaid). W-LH reports research funding (no personal honoraria) from National Health Research Institutes and Ministry of Science and Technology in Taiwan, and the National Taiwan University Hospital Yunlin Branch. He has received consultation fees from Janssen, Servier, and Boehringer Ingelheim. He has given lectures with personal honoraria for Janssen, Servier, Pfizer/Viatris, Sumitomo, Otsuka, and Boehringer Ingelheim. CB reports research funding (no personal honoraria) from the UK National Institute for Health Research and the European Commission's Horizon 2020 Framework Programme. He has received remuneration from Wiley for editing a book. AW reports research funding (no personal honoraria) from the Werner Otto Foundation. She has received remunerations for a lecture at the Lindauer Psychotherapietage and she has been treasurer of the EAPM (unpaid) since 2021. JLL has received royalties from American Psychiatric Publishing for two books and from UpToDate for several topic entries. He has received a one-time payment from the American Psychiatric Association (APA) for a course presented at the 2023 APA meeting. He has received expert witness fees in legal cases, none of which are related to the topic of this Review. PH reports research funding (no personal honoraria) from the German Research Foundation, the German Federal Ministry of Education and Research, and the German Innovation Committee at the Joint Federal Committee. He has received remunerations for a book chapter from Oxford University Press and for a book from Springer Nature. He has received remunerations as a scientific programme consultant of the Lindauer Psychotherapietage and has received payment of travel expenses and remunerations for presentations at several universities and other public hospitals in Germany (no commercial companies). He has received travel expenses and registration fees for the German Congress of Psychosomatic Medicine. He has received remunerations as a committee member from Aarhus University, Denmark. He has been a board member of the EAPM (unpaid) since 2023.
References
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Research Materials
