Management of functional somatic syndromes.
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. 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. Pharmacological agents with CNS action seem to be more consistently effective than drugs aiming at restoration of peripheral physiological dysfunction. A balance between biomedical, organ-oriented, and cognitive interpersonal approaches is most appropriate at this truly psychosomatic interface. In view of the iatrogenic component in the maintenance of FSS, doctor-centred interventions and close observation of the doctor-patient relationship are of particular importance.
Henningsen
Peter
P
Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Langerstrasse 3, 81675 Munich, Germany. p.henningsen@tum.de
Zipfel
Stephan
S
Herzog
Wolfgang
W
D015984:Causality; D002637:Chest Pain / Q000628:therapy; D002908:Chronic Disease; D004415:Dyspepsia / Q000628:therapy; D019317:Evidence-Based Medicine / Q000379:methods; D015673:Fatigue Syndrome, Chronic / Q000628:therapy; D005356:Fibromyalgia / Q000628:therapy; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000628:therapy; D017116:Low Back Pain / Q000628:therapy; D017699:Pelvic Pain / Q000628:therapy; D017410:Practice Guidelines as Topic; D013001:Somatoform Disorders / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D018781:Tension-Type Headache / Q000628:therapy; D009626:Terminology as Topic