Medically unexplained symptoms

Possible causes of medically unexplained symptoms

Many people with medically unexplained symptoms, such as tiredness, pain and heart palpitations, also have depression or anxiety.

Treating an associated psychological problem can often relieve the physical symptoms.

For others, the symptoms may be part of a poorly understood syndrome, such as:

• chronic fatigue syndrome (CFS) – also known as ME 
• irritable bowel syndrome (IBS)
• fibromyalgia (pain all over the body)

The fact that doctors are unable to find a condition causing these symptoms isn't unusual in medicine, and it doesn't mean that nothing can be done to help you.

How your GP can help 

Your GP will aim to rule out all the possible conditions that might be causing your symptoms. You may have a thorough physical examination and blood tests.

It's important to consider whether any medication you're taking may be causing your symptoms – for example, taking painkillers long term can lead to painkiller headaches.

Your GP should also investigate whether you might have an associated problem, such as depression or anxiety. Physical symptoms can cause depression and anxiety, and these can in turn make the physical symptoms worse, creating a vicious circle.

You should tell your GP:

• what your symptoms are like – when they started and what makes them better or worse
• what you think or fear is the cause of your symptoms – and your expectations of how tests and treatments might help 
• how your symptoms affect what you can do – what they stop you doing
• how upsetting your symptoms are – how they make you feel

There are a number of things you can do yourself that may help.

You and your GP may identify some lifestyle changes and goals that you both think will help relieve your symptoms, such as regular physical activity and better rest (see below).

You may be referred for a talking therapy, such as cognitive behavioural therapy (CBT). The aim of CBT is to help you to manage your symptoms by enabling you to understand links between your symptoms, worries, feelings and how you cope.

If your symptoms seem to be caused by a problem with the nervous system, you may be referred to a neurologist (a specialist in disorders of the nervous system).

The neurologist may refer you for psychotherapy but will also consider other therapy options, such as physiotherapy or occupational therapy .

Medication such as antidepressants can be helpful, even if you're not depressed. However, medication isn't always the answer – painkillers or sedatives, for example, may lead to dependence. The possible benefits of medication always need to be weighed against the potential side effects.

If you think you have an underlying condition that's been missed by your doctor, you can ask for a second opinion.

Self-help

There are things you can do to improve or even relieve some physical symptoms, such as taking regular exercise and managing stress.

Regular exercise will help keep you fit and many people find that it also boosts their mood (read about exercise for depression). How much exercise you should do will depend on your current health and capabilities.

Managing stress is very important because it's been linked to problems such as pain and IBS. Learn about breathing exercises for stress.

Generally, planning some pleasurable personal time to unwind should help – whatever helps you relax, whether it's yoga classes, swimming, running, meditation or walking in the countryside.

Read five steps to mental wellbeing.

Your body has a remarkable ability to recover and there's a good chance that your symptoms will improve in time, even without any specific treatment.

Who's affected

Unexplained symptoms tend to be more common among:

• women
• younger people
• people who've recently had an infection or physical illness, or those affected by the ill health or death of a relative
• people who've previously experienced problems such as depression and anxiety