[Note: functional somatic syndromes include Chronic Fatigue Syndrome, irritable bowel syndrome, Fibromyalgia and other “disorders that are primarily symptom-based, multisystemic in presentation, and probably involve alterations in mind-brain-body interactions.”]
Journal: Lancet. 2007 Mar 17;369(9565):946-55.
Authors and affiliation: Henningsen P, Zipfel S, Herzog W. Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany. [E-mail: firstname.lastname@example.org ]
Although functional somatic syndromes (FSS) show substantial overlap, treatment research is mostly confined to single syndromes, with a lack of valid and generally accepted diagnostic criteria across medical specialties.
Here we review management for the full variety of FSS, drawn from systematic reviews and meta-analyses since 2001, and give recommendations for a stepped care approach that differentiates between uncomplicated and complicated FSS. n Non-pharmacological treatments involving active participation of patients, such as exercise and psychotherapy, seem to be more effective than those that involve passive physical measures, including injections and operations. n Pharmacological agents with CNS (central nervous system) action seem to be more consistently effective than drugs aiming at restoration of peripheral physiological dysfunction. n A balance between biomedical, organ-oriented, and cognitive interpersonal approaches is most appropriate at this truly psychosomatic interface. n In view of the iatrogenic [“dysfunctional symptoms in the patient that owe their cause to the actions of the practitioner”] component in the maintenance of FSS, doctor-centered interventions and close observation of the doctor-patient relationship are of particular importance.