All letters are subject to editing and may be shortened. General letters can be sent to bjgpdisc{at}rcgp.org.uk (please include your postal address for publication), and letters responding directly to BJGP articles can be submitted online via eLetters. We regret we cannot notify authors regarding publication.
For submission instructions visit: bjgp.org/letters
The authors of this article make frequent reference to ‘unexplained’ and even ‘unexplainable’ symptoms.1 However, the work of Professor Christopher Burton, among others, has clearly identified helpful explanations for such functional symptoms. Using more positive language about normal ageing (wear and repair), the effects of chronic muscle tension and weakness (back pain, deconditioning), the effects of vicious cycles of focusing on symptoms and ignoring pain-free periods (by both doctors and patients), and the effects of the adrenocorticoid system are some of the helpful ways to talk about functional symptoms.2–4 Dobbin has highlighted the need for doctors to understand the mind– body relationship and the healing potential for positive social and other feedback via parasympathetic networks.5
We can recognise the predisposing factors arising from the effects of trauma and attachment processes in infancy and early childhood, which influence how distress of all kinds is communicated to doctors.6 Van der Kolk has elucidated the neurological correlates of abnormal responses to distress; beginning in childhood, stress chronically affects the cortisol axis and affects the brain’s responses.7 When we manage distress and insecure attachment skilfully, avoiding unhelpful labels and treating symptoms, we enable better emotional regulation. Mindfulness, ‘HeartMath’, and bodywork therapies such as yoga are also helpful.
Such patients need long-term supportive relationships with clinicians whose consultation skills enable therapeutic conversations. Doctors should be liberated from the idea that if the tests are normal ‘there must be something wrong that another test will find’ or that symptoms are ‘unexplained’ if there is no structural change. As up to 50% of the patients may have functional syndromes, every clinician should have excellent explaining skills for these phenomena.
Let us abandon the term ‘medically unexplained symptoms’. The origins of functional syndromes can be understood, we can explain them, and we can treat them in collaboration with our long-suffering patients.
- © British Journal of General Practice 2017