BACKGROUND: There are no proven, comprehensive treatments in primary care for patients with medically unexplained symptoms (MUS) even
though these patients have high levels of psychosocial distress, medical disability, costs, and utilization. Despite extensive
care, these common patients often become worse.
OBJECTIVE: We sought to identify an effective, research-based treatment that can be conducted by primary care personnel.
DESIGN: We used our own experiences and files, consulted with experts, and conducted an extensive review of the literature to identify
two things: 1) effective treatments from randomized controlled trials for MUS patients in primary care and in specialty settings;
and 2) any type of treatment study in a related area that might inform primary care treatment, for example, depression, provider-patient
relationship.
MAIN RESULTS: We developed a multidimensional treatment plan by integrating several areas of the literature: collaborative/stepped care,
cognitive-behavioral treatment, and the provider-patient relationship. The treatment is designed for primary care personnel
(physicians, physician assistants, nurse practitioners) and deployed intensively at the outset; visit intervals are progressively
increased as stability and improvement occur.
CONCLUSION: Providing a comprehensive treatment plan for chronic, high-utilizing MUS patients removes one barrier to treating this common
problem effectively in primary care by primary care personnel.
Key words physical symptoms - somatization - somatoform - primary care - evidence-based
This work was supported by National Institute of Mental Health grant MH57099.