Course of medically unexplained physical symptoms (MUPS) and underlying mechanisms, a long term follow-up study

Clinicians should take note of the diversity in course patterns among patients with persisting somatic symptoms. We advise them to explore the patients’ experiences with fluctuations in symptom severity and functioning, and the consequences of symptom exacerbations for daily life. Regarding coordination of care, we recommend shared decision-making in which the GP provides active guidance through the healthcare landscape. An important role for the GP and other health care providers is to guide and help patients shift their focus from seeking a diagnosis and cure to symptom acceptance, improving patients’ symptom management strategies and focusing on achievable goals that improve their quality of life. 

Regarding the mechanisms we explored, clinicians can ask about these mechanisms during symptom exploration and then integrate our findings on these mechanisms when co-creating personalized explanations for PSS with their patients. 

Many participants already had symptoms for several years. Research focusing on patients with newly presented symptoms in general practice might provide valuable knowledge about factors that influence the course and prognosis. In which patients do symptoms resolve quickly, whose symptoms persist?

The fluctuations in symptoms we found are another area where we need more research: what are possible mechanisms of these fluctuations? It would be useful to study the health care use of PSS patients more extensively. We recommend addressing the obstacles and barriers in care coordination and collaboration when somatic symptoms persist, both from the healthcare professionals’ and the patients’ viewpoint.