Medically unexplained symptoms

Many people have persistent physical problems that do not appear to be symptoms of a medical condition. For example, dizziness or pain

Your symptoms may last more than a few weeks and doctors cannot find the cause. This is sometimes called 'medically unexplained symptoms'.

This does not mean the symptoms are fake or 'all in the head'. They're real and can affect your ability to function.

Not knowing the cause can make the symptoms more difficult to cope with and distressing.

Your symptoms may be caused by problems in your nervous system. This could be a functional neurological disorder.

Symptoms of a functional neurological disorder can include:

• tingling in the hands or feet
• a tremor in one or both arms
• headaches or migraines
• changes in eyesight, like blurred vision or seeing flashing lights

Medically unexplained symptoms are common. They can account for up to 45% of GP appointments.

Causes of medically unexplained symptoms

Many people with medically unexplained symptoms, such as tiredness or pain, 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:

• irritable bowel syndrome (IBS)
• fibromyalgia (pain all over the body)

Your GP may not find a condition that causes your symptoms. This is not unusual. It does not mean that they can do nothing to help you.

How your GP can help

Your GP will try to rule out the possible conditions that could cause your symptoms. You may have a physical examination and blood tests.

They will check if any medication you're taking can cause your symptoms. For example, taking painkillers for a long time can cause painkiller headaches.

Your GP will check if you might have a related problem, such as depression or anxiety.

Physical symptoms can cause depression and anxiety. These conditions can also make physical symptoms worse. This can create a cycle that is hard to break.

Tell your GP:

• what your symptoms are like, when they started and what makes them better or worse
• what you think is the cause of your symptoms
• how your symptoms affect what you can do and what they stop you from doing
• how upsetting your symptoms are and how they make you feel

There are some things you can do that may help. Tell your GP how you expect tests and treatments might help.

You and your GP may discuss some lifestyle changes and goals that may help improve your symptoms. For example, regular physical activity and better rest.

Your GP may refer you for talking therapy, such as cognitive behavioural therapy (CBT). This is to help you to manage your symptoms. It can help you to understand links between your symptoms, worries, feelings and how you cope.

If the cause of your symptoms may be a problem with the nervous system, your GP may refer you to a neurologist. A neurologist is a specialist in disorders of the nervous system.

The neurologist may refer you for psychotherapy. They 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. But medication is not always the answer. Your doctor will discuss the possible benefits of medication and any side effects or risks. For example, painkillers or sedatives can lead to dependence.

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

Self-help

You can do things to improve some physical symptoms, such as doing regular exercise and managing stress.

Regular exercise helps keep you fit and boosts your mood. How much exercise you should do depends on your health and abilities.

Why exercise helps your physical and mental health

Managing stress is very important because there can be a link with problems such as pain and IBS.

Planning some personal time to unwind can help. Do activities that help you relax, such as running, meditation or walking.

Things you can do to support your mental health

Your body has a strong ability to recover. Symptoms can improve in time, even without any specific treatment.

Who's affected

Unexplained symptoms are more common among:

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