Medically unexplained symptoms
It goes like this: someone spends months with dizziness, pain or exhaustion, goes through test after test, and the results and scans come back normal every…
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Medicines commonly prescribed for Medically unexplained symptoms
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 90 mgActive substance: duloxetineManufacturer: Esteve Pharmaceuticals S.A.Prescription requiredDosage form: CAPSULE, 60 mgActive substance: duloxetineManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: amitriptylineManufacturer: Pan Quimica Farmaceutica S.A.Prescription required
It goes like this: someone spends months with dizziness, pain or exhaustion, goes through test after test, and the results and scans come back normal every time. Complaints like these are called medically unexplained symptoms. The name is an unfortunate one, because it sounds like a verdict of "there is nothing wrong with you", when it means something quite different: no single disease has been found that accounts for everything at once. The symptoms themselves are real, they get in the way of work and daily life, and there is a great deal that can be done about them.
What the phrase actually means
The first thing worth understanding is that "unexplained" is not a synonym for made up, or for psychosomatic in the everyday sense, or for "it is all in your head". Nobody is pretending. Pain feels like pain, weakness genuinely stops an arm from lifting, and in an attack the person really does fall.
The point is that the body can work badly without any visible breakage: the nervous system processes signals differently from how it should, while the organs themselves are intact. That is why medicine is moving away from the word "unexplained" and increasingly talks about functional disorders. This is not renaming for the sake of politeness: behind the newer term sits an understanding of the mechanism, and a treatment that follows from it.
These complaints are very common. In general practice they account for a substantial share of all consultations, by various estimates up to a quarter. So anyone who has them is far from unusual, and certainly not a "difficult case".
What they look like
Almost any organ can be involved, but some complaints turn up far more often than others:
- pain in the muscles, joints, back and neck;
- headaches, often daily ones;
- draining tiredness that sleep does not lift;
- dizziness and a feeling of being about to faint;
- chest pain and awareness of the heartbeat;
- bloating, abdominal pain, alternating diarrhoea and constipation;
- a feeling of not getting enough air, or a lump in the throat.
Less often, but regularly, there is numbness and tingling, weakness in an arm or leg to the point of not being able to use it, tremor, difficulty walking, disturbances of speech and vision, and attacks with loss of control that resemble epileptic seizures.
One characteristic detail: there are usually several symptoms at once, they shift over time, and their intensity swings from day to day in a way that clearly tracks what the person has been doing and how tired they are.
Why the body hurts when nothing is found
The nervous system does not simply relay signals; it processes them and fills in the gaps. The brain is constantly predicting what ought to be happening in the body and comparing that prediction with what arrives. Once it has tuned itself to a particular frequency, it starts reading ordinary bodily sensations as alarms.
This is sensitisation, an increase in the sensitivity of the nerve pathways. The channels that carry pain amplify the signal, and what previously went unnoticed, such as the stretch of the bowel after a meal or ordinary muscle tension, comes to be felt as pain.
The second mechanism is the autonomic nervous system. Under strain it speeds the heart, quickens the breathing and alters gut movement and muscle tone, which is where palpitations, dizziness, loose stools and breathlessness come from. These responses are normal in themselves; what is not normal is that they switch on for long stretches and without cause.
The third is attention. Focusing on a symptom makes it stronger, as anyone who has ever listened to their own heart in a quiet room will recognise. In functional movement disorders it is strikingly visible: the hand will not obey when someone tries to move it deliberately, yet works normally during an automatic action.
What keeps the cycle going
The symptom almost always begins with something specific: an infection, an injury, an operation, a poisoning, severe stress or a hard stretch of life. The event passes, but the setting stays, and from then on other things sustain it.
The main one is anxiety, which is only natural when you have no idea what is happening to you. Anxiety sharpens sensations, sensations feed the anxiety, and the loop closes. Low mood works the same way: depression and anxiety disorders are considerably more common in these patients, and often as a consequence rather than a cause.
Everyday things sustain the loop too: poor sleep, giving up physical activity entirely for fear of doing harm, and long-term painkiller use, since taking headache medicine every day eventually causes headaches, and that can only be broken by withdrawing it under medical supervision. The search for a diagnosis feeds the loop as well: each new test reassures for a while, then the worry returns and another one is needed.
Conditions that do have a name
Some of these symptoms fall into recognisable patterns that have names, diagnostic criteria and established treatment. A diagnosis of that kind is not a fob-off but a specific condition.
- Irritable bowel syndrome: abdominal pain linked to opening the bowels, bloating, and alternating diarrhoea and constipation.
- Fibromyalgia: widespread pain throughout the body with fatigue, poor sleep and difficulty concentrating.
- Myalgic encephalomyelitis, also known as chronic fatigue syndrome: draining weakness that worsens sharply after exertion.
- Functional neurological disorders: weakness, tremor, difficulty walking, speaking or seeing, and attacks that outwardly resemble epileptic seizures but without changes on the electroencephalogram.
- Functional dyspepsia: heaviness and pain at the top of the stomach and early fullness with a healthy stomach.
- Chronic pelvic pain, and persistent dizziness with a normal balance system.
These conditions often travel together: someone with fibromyalgia frequently has irritable bowel syndrome as well. That is not coincidence but a consequence of the same underlying oversensitivity.
What must not be put down to functional symptoms
A diagnosis of functional disorder does not cancel out ordinary caution. Certain signs need looking at separately, even if that diagnosis has been in place for years:
- weight loss without trying, night sweats, a prolonged temperature;
- blood in the stool, black stools, blood in the urine or in coughed-up phlegm;
- a symptom that wakes you at night and does not depend on activity or mood;
- a lump you can feel, a swollen hot joint, enlarged lymph nodes;
- persistent weakness confined strictly to one area, difficulty passing urine or stool, loss of part of the visual field;
- a complaint appearing for the first time in later life;
- symptoms in someone with cancer, with HIV, or on treatment that suppresses immunity.
Call an ambulance straight away (across Europe the single number is 112) if there is crushing chest pain spreading to the arm, jaw or back; sudden weakness down one side, a drooping face or slurred speech; sudden severe breathlessness; the worst headache of your life coming on within seconds; or a first-ever seizure. An existing diagnosis of a functional disorder is no protection against a heart attack or a stroke, and the habit of explaining everything away as "my symptoms" is dangerous for precisely that reason.
How a doctor works it out
It starts with a detailed account: when it began, what it coincided with, what makes it worse and what eases it, how it changes across the day and the week. Then comes examination, and tests are requested selectively, based on what has been heard and found, rather than "let us check everything". Medicines are always reviewed: painkillers, sleeping tablets and blood pressure drugs can themselves cause headache, tiredness and dizziness.
It matters that functional disorders are not diagnosed by exclusion. They have positive signs of their own that a doctor looks for deliberately: functional weakness in a leg has characteristic manoeuvres, and in functional tremor the frequency of the shaking changes when the person is distracted. A diagnosis reached that way is dependable and does not need rechecking every year.
Endless investigation is not harmless. It turns up incidental findings unrelated to the complaint and sets off a fresh chain, bringing radiation, unnecessary procedures and years of waiting with it. If you still believe something important has been missed, asking for a second opinion is entirely reasonable; the only thing to avoid is turning it into an endless cycle.
What genuinely helps
Treatment here is not about removing a cause but about retuning the system; it works, but it takes time and the person's own involvement. The best studied approaches are psychological, above all cognitive behavioural therapy. The aim is not to convince anyone they are well, but to unpick the links between sensations, thoughts, fears and behaviour, and to remove the links that keep the loop turning.
For movement and speech problems the main treatment is not tablets but specialist rehabilitation: movement is retrained through distraction and automatic action, and occupational therapy and speech and language therapy are valuable here. For severe pain, activity is built up gradually, whereas in chronic fatigue syndrome the opposite applies and the day is organised so as not to cross the threshold beyond which everything worsens.
Of the medicines, the ones most often prescribed are antidepressants and certain anticonvulsants at low doses: in chronic pain they act not as antidepressants but by reducing the sensitivity of the pain pathways, and the effect takes several weeks to appear. Painkillers and benzodiazepine sedatives are unsuitable for continuous use: they cause dependence and end up becoming part of the problem.
What you can do yourself
What pays off most is what is done regularly and in small amounts, not in bursts.
Start with sleep: a fixed waking time, no screens before bed and no catching up with daytime naps achieve more than you would expect. Then movement. Begin at a level you can definitely manage on a bad day and add a little every week or two. A burst of effort followed by a week in bed is the commonest mistake of all.
Keep a diary: the symptom, how strong it was, what came before it, how much you slept. After a month or two the patterns become visible and the conversation with the doctor becomes concrete. Set goals in terms of activities rather than sensations: "walk to the shop" instead of "stop hurting".
Learn something that works with the body and the breath, whether slow breathing, muscle relaxation, mindfulness practice, yoga or swimming. This is not "relax and it will pass" but a way of lowering the activity of the autonomic nervous system. And keep up contact with people: isolation worsens symptoms about as reliably as lack of sleep does.
Online consultation with a doctor
For complaints like these an online appointment fits particularly well: most of the work is a detailed conversation and a review of what has already been done, rather than an examination. The doctor will hear the whole story rather than five minutes of it, look through the tests and reports you already have, say which of them is genuinely worth repeating and which need not be redone, and check whether the medicines you take are feeding the symptoms. Together you can go through a symptom diary, draw up a plan for sleep and activity, and work out which specialist it makes sense to see next. Upload your results and a full list of your medicines with doses in advance. Where the signs listed under emergency care are present, an online appointment is not the right route: an ambulance is.
This material is for information only and does not replace medical advice.
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