- Messages
- 1,446
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We do ourselves no favours by buying into and perpetuating the terminology ‘Medically Unexplained Symptoms, or ‘MUS’
The term Medically Unexplained Symptoms (MUS) is historically (and currently) favoured by Sharpe, Stone, Wessely, Fink, Creed, Aylward (UNUM), etc, and used interchangeably with ‘Functional’, or ‘Functional Syndromes/Functional Somatic Syndromes’, which is an alternative term for ‘Psychosomatic-but-we-don’t-want-to-say-so’ ’.
The treatment is always CBT.
The above named parties have been perpetuating such semantic gymnastic double speak for decades (a practice which could be termed ‘Obscuring By Language’, or ‘OBL’.)
~~~~~~~~~~~~~~
http://www.iapt.nhs.uk/silo/files/medically-unexplained-symptoms-postive-practice-guide-2014.pdf
NHS Guide
Improving Access to Psychological Therapies. IAPT.
Medically Unexplained Symptoms/ Functional Symptoms
Positive Practice Guide
1.5
A recent systematic review of the economics of MUS found two main results: first, medically unexplained symptoms cause direct excess treatment costs per patient (between 432 and 5,353 USD per annum); second, interventions targeting GP’s diagnostic and patient management skills as well as CBT for patients have the potential to improve patients’ health status and to reduce costs
(3)
.
2.2.4
The term may appear dismissive and provides the message that nothing can be done. This is inaccurate as there are evidenced based approaches which show that methods such as CBT and graded exercise are effective treatments for these conditions.
2.2.5
Similar approaches also assist patients with well recognised medical conditions reduce the severity of symptoms and disability associated with the symptoms. Therefore the fact that psychological treatments works does not mean that the illness is psychological.
2.3
The IAPT MUS Task and Finish group strongly advises that when engaging or treating patients, the term MUS is not used. The experience of experts working in this field is that where possible patients should be given a specific diagnosis of a syndrome which describes their central symptom(s) without inferring that the aetiology is psychological. Common syndromes include:
-
Fibromyalgia
-
Irritable Bowel Syndrome
-
Chronic Fatigue Syndrome
-
Tempromandibular Joint (TMJ) dysfunction
-
Atypical facial pain
-
Non-Cardiac l chest pain
-
Hyperventilation
-
Chronic Cough
-
Loin Pain haematuria syndrome
-
Functional Weakness / Movement Disorder
-
Dissociative (Non-epileptic) Attacks
-
Chronic pelvic pain/ Dysmenorrhoea
2.4
Many of these conditions have published diagnostic criteria which can be used in diagnosis
6. Stone, J., Wojcik, W., Durrance, D., Carson, A.,Lewis, S., MacKenzie, L., Warlow, C.P., Sharpe, M
What should we say to patients with symptoms unexplained by disease? The "number needed to offend". BMJ 2002;325;1449-1450
7
Creed, F., Henningsen, P., & Fink, P. (2011).
Medically unexplained symptoms, somatisation and bodily distress. Cambridge: Cambridge University Press.
Other terms in use which appear more acceptable to patients include persistent physical symptoms or functional syndromes/symptoms (FS)
(8)
The term “functional” here is used because it is assumed that the disorder is one of function, which may be physical and/or psychosocial function, rather than anatomical structure.
Sharpe (9) likens this distinction to a car that needs tuning rather than a car which has mechanical damage. More recently, physiologically explained symptoms have also proposed as an alternative. For the rest of this paper we will refer to functional symptoms or syndromes (FS) rather than MUS.
8
Stone, J., Wojcik, W., Durrance, D., Carson, A.,
Lewis, S., MacKenzie, L., Warlow, C.P., Sharpe, M
What should we say to patients with symptoms unexplained by disease? The "number needed to offend". BMJ 2002;325;1449-1450
9
Sharpe, M. (2000). Functional somatic syndromes: Etiology, diagnosis and treatment by Peter Manu (book review). Biological Psychology, 53, 93-97
.
We do ourselves no favours by buying into and perpetuating the terminology ‘Medically Unexplained Symptoms, or ‘MUS’
The term Medically Unexplained Symptoms (MUS) is historically (and currently) favoured by Sharpe, Stone, Wessely, Fink, Creed, Aylward (UNUM), etc, and used interchangeably with ‘Functional’, or ‘Functional Syndromes/Functional Somatic Syndromes’, which is an alternative term for ‘Psychosomatic-but-we-don’t-want-to-say-so’ ’.
The treatment is always CBT.
The above named parties have been perpetuating such semantic gymnastic double speak for decades (a practice which could be termed ‘Obscuring By Language’, or ‘OBL’.)
~~~~~~~~~~~~~~
http://www.iapt.nhs.uk/silo/files/medically-unexplained-symptoms-postive-practice-guide-2014.pdf
NHS Guide
Improving Access to Psychological Therapies. IAPT.
Medically Unexplained Symptoms/ Functional Symptoms
Positive Practice Guide
1.5
A recent systematic review of the economics of MUS found two main results: first, medically unexplained symptoms cause direct excess treatment costs per patient (between 432 and 5,353 USD per annum); second, interventions targeting GP’s diagnostic and patient management skills as well as CBT for patients have the potential to improve patients’ health status and to reduce costs
(3)
.
2.2.4
The term may appear dismissive and provides the message that nothing can be done. This is inaccurate as there are evidenced based approaches which show that methods such as CBT and graded exercise are effective treatments for these conditions.
2.2.5
Similar approaches also assist patients with well recognised medical conditions reduce the severity of symptoms and disability associated with the symptoms. Therefore the fact that psychological treatments works does not mean that the illness is psychological.
2.3
The IAPT MUS Task and Finish group strongly advises that when engaging or treating patients, the term MUS is not used. The experience of experts working in this field is that where possible patients should be given a specific diagnosis of a syndrome which describes their central symptom(s) without inferring that the aetiology is psychological. Common syndromes include:
-
Fibromyalgia
-
Irritable Bowel Syndrome
-
Chronic Fatigue Syndrome
-
Tempromandibular Joint (TMJ) dysfunction
-
Atypical facial pain
-
Non-Cardiac l chest pain
-
Hyperventilation
-
Chronic Cough
-
Loin Pain haematuria syndrome
-
Functional Weakness / Movement Disorder
-
Dissociative (Non-epileptic) Attacks
-
Chronic pelvic pain/ Dysmenorrhoea
2.4
Many of these conditions have published diagnostic criteria which can be used in diagnosis
6. Stone, J., Wojcik, W., Durrance, D., Carson, A.,Lewis, S., MacKenzie, L., Warlow, C.P., Sharpe, M
What should we say to patients with symptoms unexplained by disease? The "number needed to offend". BMJ 2002;325;1449-1450
7
Creed, F., Henningsen, P., & Fink, P. (2011).
Medically unexplained symptoms, somatisation and bodily distress. Cambridge: Cambridge University Press.
Other terms in use which appear more acceptable to patients include persistent physical symptoms or functional syndromes/symptoms (FS)
(8)
The term “functional” here is used because it is assumed that the disorder is one of function, which may be physical and/or psychosocial function, rather than anatomical structure.
Sharpe (9) likens this distinction to a car that needs tuning rather than a car which has mechanical damage. More recently, physiologically explained symptoms have also proposed as an alternative. For the rest of this paper we will refer to functional symptoms or syndromes (FS) rather than MUS.
8
Stone, J., Wojcik, W., Durrance, D., Carson, A.,
Lewis, S., MacKenzie, L., Warlow, C.P., Sharpe, M
What should we say to patients with symptoms unexplained by disease? The "number needed to offend". BMJ 2002;325;1449-1450
9
Sharpe, M. (2000). Functional somatic syndromes: Etiology, diagnosis and treatment by Peter Manu (book review). Biological Psychology, 53, 93-97
.
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