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Doctors Give Hope to Patients With Long Histories of Unexplained Symptoms

By DAN HURLEY Published: August 22, 2006 People with a long history of medically unexplained symptoms — aches, pains, fatigue, dizziness and other complaints for which doctors can find no physical cause — might finally find relief. Two new studies by researchers who specialize in the baffling condition called somatization syndrome, estimated to affect up to 3 percent of adults, suggest that the quest for a physical explanation may take on a destructive life of its own. Instead, those with the syndrome should focus on practical strategies to regain normal function and relieve symptoms, the researchers say.

One study, by German scientists, sought to explain why the doctors’ reassurances were generally ineffective with such patients. The researchers played taped comments by a doctor about a hypothetical patient for two groups of participants, people who had the syndrome and people who did not. Those with somatization syndrome were three times as likely to believe incorrectly that in the course of the comments the doctor had said the symptom had a worrisome physical cause.

The findings, in the August issue of the online journal Public Library of Science Medicine, offer at least a partial explanation for why patients often go from doctor to doctor and take test after test in a fruitless search for answers: repeated reassurances are simply not being understood. A second study, by New Jersey researchers, provides the first published evidence of an effective clinical treatment. The study, in the July 24 issue of The Archives of Internal Medicine, found that patients benefited from 10 sessions of cognitive behavioral therapy specifically organized to help relieve their stress and increase emotional awareness and to get them to become more socially active and think differently about their symptoms. “For patients who have these symptoms, their lives are about going to doctors, being physically incapacitated and worrying about it,” said the lead author of the study, Dr. Lesley A. Allen, associate professor of psychiatry at the University of Medicine and Dentistry of New Jersey. “They stop their dance classes and don’t go to work and don’t spend as much time throwing the ball with their kids,” Dr. Allen said. “Our treatment emphasizes changing their behaviors, trying to change the focus of their lives from worrying about their symptoms to re-engaging in activities they’ve been avoiding.”

The 84-patient study, compared the behavior therapy with the standard treatment. In that approach, primary care doctors avoid telling patients that the symptoms are “all in their head” or trying to dismiss them by sending them for unnecessary tests or to specialists. Rather, doctors examine the parts of the body of concern to the patient, convey that nothing appears to be seriously wrong, treat underlying anxiety or depression and schedule regular return visits. Dr. Allen, whose book on the new treatment is due out in October, treats patients at the university’s facility for medically unexplained symptoms, one of the few such centers in the country.

Dr. Arthur J. Barsky, a psychiatrist at Harvard, called the findings very helpful. In 2004, Dr. Barsky published a study showing that cognitive behavior therapy was similarly helpful in treating hypochondriasis, a related disorder in which patients are sure they have a specific illness although no evidence can be found. “We’re starting to gather evidence that with these approaches, people really can cope better and feel better,” Dr. Barsky said.

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