We searched the Cochrane Library, MEDLINE, and PSYCINFO from 2001. We used a string of search terms previously applied in a meta-analysis on FSS and diagnostic analogues and adapted it to the terms of FSS that are indicated in table 1. We included commonly referenced and highly regarded publications from before 2001. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. For the section on therapeutic evidence we restrict
ReviewManagement of functional somatic syndromes
Introduction
Functional somatic syndromes (FSS) are common worldwide and in practically all areas of medicine. FSS are a burden for sufferers, they are also often difficult to treat for doctors and costly for society.1, 2, 3 Diagnostic and therapeutic approaches to FSS vary substantially across and within medical specialties, from biomedicine to psychology. In this review, we try to improve the understanding of common factors across single FSS and hence of common therapeutic strategies across medical specialities. We give an overview of current concepts underlying the management of FSS, of results of appropriate therapeutic trials in single syndromes and diagnostic analogues, and of practical steps for management.
Section snippets
Definition, overlap, terminology, and classification
FSS are characterised by patterns of persistent bodily complaints for which adequate examination does not reveal sufficiently explanatory structural or other specified pathology. We differentiate three main types of bodily complaints in FSS: pain of different location (back, head, muscles or joints, abdomen, chest, etc); functional disturbance in different organ systems (eg, palpitation, dizziness, constipation or diarrhoea, movement, sensation); and complaints centring around fatigue and
Aetiology and pathophysiology
Management of FSS must be informed by knowledge about the diversity of predisposing, precipitating, and maintaining factors for FSS. In terms of predisposing factors, no clear pattern of genetic influences has been identified, and the heritability of FSS seems to be small.29, 30 Childhood adversities are not restricted to sexual or physical abuse.31 Childhood experience of organically unexplained symptoms, parental ill health, and increased parental illness behaviour for bodily symptoms in the
Balanced approaches to FSS
There is not one single focus in the management of FSS, and this ambiguity has to be seen as a characteristic feature of these syndromes (panel 1). Some patients (eg, those with uncomplicated irritable bowel syndrome) will benefit most from typical medical interventions that are limited to reassurance and symptomatic relief focussed on gut functioning, but diagnostic elements of the cognitive interpersonal approach have to be integrated to assure that there are no symptoms or problems beyond
Description of treatment foci and types
We could not identify trials that tested treatments of groups of patients fulfilling criteria for more than one FSS. Differentiation of the following five treatment foci and types is useful for the organisation of the evidence on the treatment of single FSS and diagnostic analogues, such as somatoform disorders (table 2),51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94,
Management of functional somatic syndromes as a whole
The effect of non-pharmacological passive treatments, be they invasive or non-invasive, seems to be weaker than the effect of non-pharmacological treatments that involve active patients' cooperation. The evidence for efficacy of the latter across different FSS, in particular graded exercise and psychotherapy, underlines the importance of common factors in FSS, as the therapeutic rationale of these treatments typically aims at overall function and not at the alleviation of specific symptoms. The
Conclusion
The evidence base for the management of FSS has grown considerably over the last years and many patients are served well with the treatments applied in different subspecialities of medicine. However, there is still a predominance of a splitting view on single FSS and a lack of diagnostic criteria and classifications that are valid and generally agreed upon. This not only leads to confusion, but also to the neglect of important therapeutic options for many patients. Stigmatisation of
Search strategy and selection criteria
References (131)
- et al.
Functional somatic syndromes: one or many?
Lancet
(1999) - et al.
Dhat (semen loss) syndrome: a functional somatic syndrome of the Indian subcontinent?
Gen Hosp Psychiatry
(2005) - et al.
AGA technical review on irritable bowel syndrome
Gastroenterology
(2002) MCS: the status of population-based research
Int J Hyg Environ Health
(2002)- et al.
Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?
Gastroenterol
(2002) - et al.
The no-fault flavor of disability syndromes
Med Hypotheses
(2001) - et al.
The genetics of irritable bowel syndrome
Clin Gastroenterol Hepatol
(2005) - et al.
Childhood adversity and frequent medical consultations
Gen Hosp Psychiatry
(2004) - et al.
Somatoform and personality disorders: syndromal comorbidity and overlapping developmental pathways
J Psychosom Res
(1995) - et al.
Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis
Lancet
(2001)