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Review
. 2024 Nov 26:48:101140.
doi: 10.1016/j.lanepe.2024.101140. eCollection 2025 Jan.

The overlooked burden of persistent physical symptoms: a call for action in European healthcare

Anne Toussaint  1 , Angelika Weigel  1 , Bernd Löwe  1 ; EURONET-SOMA group
Collaborators, Affiliations
Review

The overlooked burden of persistent physical symptoms: a call for action in European healthcare

Anne Toussaint et al. Lancet Reg Health Eur. .

Abstract

Regardless of their cause, persistent physical symptoms are distressing somatic complaints that occur on most days for at least several months. They are common in patients with somatic diseases, functional somatic disorders, mental disorders, and undiagnosed medical conditions and are often associated with significant impairment and medical costs. Despite their prevalence and impact, persistent physical symptoms are often overlooked in medical care. This Personal View stresses the importance of recognising persistent physical symptoms as a European health issue. It advocates improvements in research, clinical management, public health, and policy. Efforts should prioritise integrating models of symptom perception and biopsychosocial perspectives into medical care and education, fostering interdisciplinary collaboration, and developing standardised guidelines to enhance patient care, reduce stigma, and improve clinical outcomes. Increased research funding can accelerate progress in understanding and effectively managing persistent physical symptoms. Addressing these priorities will support patients and healthcare professionals, ensuring adequate care and a higher quality of life for affected individuals.

Keywords: Education; Healthcare; Persistent physical symptoms; Persistent somatic symptoms; Public health; Stigma; Treatment.

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Conflict of interest statement

AT reports research funding (no personal honoraria) from the German Research Foundation. She has received remunerations for a printed textbook from Ernst Reinhardt Publishing. 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. 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 (EJP), the Ministry of Science, Research and Equality of the Free and Hanseatic City of Hamburg, Germany, and the Foundation Psychosomatics of Spinal Diseases, Stuttgart, Germany. He received remunerations for several scientific book articles from various book publishers, from the Norddeutscher Rundfunk (NDR) 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, Cluj-Napoca, Romania, October 2023. He received a travel grant for a lecture on the occasion of the presentation of the Alison Creed Award at the EAPM Conference in Lausanne, 12–15 June 2024. He received remuneration and travel expenses for lecture at the Lindauer Psychotherapiewochen, April 2024. He is President of the German College of Psychosomatic Medicine (DKPM) (unpaid) since March 2024 and was a member of the Board of the European Association of Psychosomatic Medicine (EAPM) (unpaid) until 2022. He is member of the EIFFEL Study Oversight Committee (unpaid). KB reports honoraria as speaker for medical specialist meetings, she is an unpaid member of the board of directors at Unizo Limburg (Organisation for the Self-Employed and SMEs), and a founding member and shareholder of Tumi Therapeutics (interdisciplinary centre of expertise on the prevention, diagnostics and treatment of stress-related and persistent somatic symptoms). PE reports funding from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation; GZ: EN 1376/1-1). ToH is vice-president of the North American Primary Care Research Group (NAPCRG). TH reports honoria as a lecturer in university postgradual psychotherapy training in children and adolescent psychotherapy regarding chronic (primary) pain at the universities of Cologne (AkiP), Trier, Osnabrück and Landau. She is a member of the Open Science Committee of the Institute of Psychology of University of Muenster and a board member of the “Kinder-und Jugendlichenpsychotherapie Verhaltenstherapie” (KJPVT). KH reports funding for studies on COVID and post COVID condition by Land Tirol and honoraria for lectures-at FOMF (Forum für Medizinische Fortbildung) and Hospital of Schwaz. PeHe has received remunerations as a scientific programme consultant of the Lindauer Psychotherapietage, he has received remunerations as a committee member from Aarhus University, Denmark, he has obtained remunerations for a book chapter from Oxford University Press and for a book from Springer Nature 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, and has been a board member of the EAPM (unpaid) since 2023. PH reports research funding from the Stiftung Psychosomatik der Wirbelsäulenerkrankungen (payment made to the institution), royalties for a book chapter on somatic symptom disorder by Thieme Verlag, a scholarship for attending the ICPM 2024 conference from Carus Stiftung, he operates in his own practice for psychotherapy and receives payments by the German statutory health insurances and private health insurances. KHK reports honoria as a teaching psychologist specializing in child and adolescent psychiatry about functional somatic disorders (FSD), and on a specialist course for health care professionals working with children and adolescents with the topic of etiology, communication and treatment of FSD in children and adolescents (organized by the Danish Medical Society for Functional Disorders), she was an invited speaker at the Swedish pain forum meeting—giving a lecture on specialized treatment of children and adolescents with FSD, and is a board member of the Danish Medical Society for Functional Disorders and member of the educational committee within the medical society. NL reports grants from the European Commission, Horizon 2020 Framework Programme Marie Sklodowska Curie Innovative Training Network ETUDE (project 956673), the German Federal Ministry of Education and Research (The German Centre for Mental Health), and the German Research Foundation (project LE 3754/2-1) (payments to institution), payments for article publication by Psychotherapie im Dialog and lectures at Benedictus Krankenhaus Feldafing GmbH & Co KG; ZAIM Medidays Zurich, she received Payments to attend meetings and to travel by TUM University Hospital, Munich, and is a founding member and stockholder of EyeSeeTec GmbH, Munich. AM reports honoraria for lectures and educational workshops about diagnostic assessment (Akademie für Psychologie BÖP, Vienna), characteristics and treatment of somatic symptom disorders (University of Zurich; University of Osnabrueck; The Medical Association of Lower Saxony), and travel support for EURONET SOMA group meetings (funded by own institution). CP is a board member of the European Associatoion of Psychosomatic Medicine (EAPM) and council member of the World Federation of Psychotherapy (WFP). JR reports a research grant from Krajowa Izba Lekarsko-Weterynaryjna (National Veterinarians Board) for conducting national study of work burnout of vets, consulting fees by Jansen Cilag sa and Sympomed sp z o.o as a member of the advisory board, speaker honoraria for preparation, development and delivery of author lectures on 1) Metabolic side effects in people with schizophrenia during intermediate and long-term treatment with antipsychotic drugs 2) Use of neuromodulation in the treatment of eating disorders–update 2024. WR reports research grants from the German Research Foundation DFG, the Ministry of Science and Arts Hessian (LOEWE Hessian Excellence Centre DYNAMIC), royalties for book publications (Hogrefe, Göttingen), honoraria from Boehringer Ingelheim for workshops on Long COVID, and payment for expert testimony at the Hessian Institute for Health and Care (HLfGP). MR reports grants from TrygFonden and Innovation Fund Denmark (payments were made to institution), she receives royalties for book chapters by Gyldendal, and payment for a keynote presentation at Swedish Pain Society, she is chair of the Danish Society of Functional Disorders (unpaid). JGMR reports research grants by ZonMw, EU, NOW and NIMH, she received royalties for a handbook on persistent somatic symptoms by Lannoo Publishers, she is a winner of the Wayne Katon Research Award (ACLP) (paid to university), is member of a Data Safety Monitoring Board and Advisory Board of SOMACROSS research unit (FOR 5211) (unpaid), vice-president of the European Association of Psychosomatic Medicine, EAPM (unpaid), and president of the Dutch Network Persistent Somatic Symptoms, NALK (unpaid). MS reports honoraria for lectures and presentations. RS reports honoraria as a speaker from Novartis for a lecture on psychodermatology, he is a member of the board of trustees of the Foundation Psychosomatic and Social Medicine (Ascona Foundation), coeditor of the German AWMF S3-Guidelines on Functional Complaints, and contributed to the German guidelines on irritable bowel syndrome, and on Lyme Borreliosis, he is chairman of the Basel Institute for Psychosomatic Medicine (BIPM) and founder and managing director of the Psychosomatic and Psychosocial Services GmbH, that develops and implements psychosomatic and psychosocial training and continuing education programs. StSa reports funding from the German Research Foundation (Grant number: SA 4505/3-1). MSM reports grants from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation): Research funding for the SOMACROSS research unit (RU 5211), subproject leader (payment to institution); Deutscher Akademischer Austauschdienst (DAAD, German Academic Research Service): Funding for research exchange programme to UNSW Sydney, Australia (Payment to institution); Deutsche Forschungsgemeinschaft (DFG, German Research Foundation): Research funding for the Transregional Research Unit Treatment Expectation (TRR 289), subproject leader (payment to institution), she reports honoraria for review of grant proposal from University of Toledo, USA, and consulting fees by Norddeutscher Rundfunk (NDR), Hamburg: Remuneration for interviews in medical knowledge programmes on public television, Hafencity-Institut für Psychotherapieausbildung (HIP), Hamburg: Honoraria for post graduate training for psychotherapy, Institut für Psychotherapieausbildung (IfP), Hamburg: Honoraria for post graduate training for psychotherapy, Institut für Psychotherapieausbildung Marburg (IPAM), Marburg: Honoraria for post graduate training for psychotherapy, she is a member of the scientific advisory board at PKD Cure e.V. (unpaid), and executive board member and vice-treasurer of the European Association of Psychosomatic Medicine (EAPM) (unpaid). JS reports royalties for articles on Functional Neurological Disorder (FND) from UpToDate, payment for expert testimony within expert witness work for UK legal firms in personal injury and negligence cases, board, he is secretary of the FND Society since 2019, on the medical advisory board of FND Hope and FND hope UK, and on the medical advisory board of FND Action, he runs neurosymptoms.org—a free self-help website for people with FND. LT reports honoraria for educational lectures on somatic symptom disorder and functional neurological disorder (paid to institution) and is (unpaid) chair of the Dutch network for Persistent Somatic Symptoms (NALK). UW reports honoraria from Lundbeck and Janssen and is a member of the scientific committees for Janssen and Teva. MW reports honoraria as speaker for several CBT training courses at different universities, reimbursement of travel expenses from the Johannes Gutenberg University of Mainz, he is member and co-chairman of the ethics committee of the Department of Psychology at the Johannes Gutenberg University Mainz, and reports royalties for different scientific book chapters and a CBT treatment manual for medically unexplained somatic symptoms. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Key points to advance care for persistent somatic symptoms.
See this image and copyright information in PMC

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