 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 May 2001 | Volume 134 Issue 9 Part 2 | Pages 868-881
Purpose: Unexplained clinical conditions share features, including symptoms (fatigue, pain), disability out of proportion to physical examination findings, inconsistent demonstration of laboratory abnormalities, and an association with "stress" and psychosocial factors. This literature review examines the nature and extent of the overlap among these unexplained clinical conditions and the limitations of previous research.
Data Sources: English-language articles were identified by a search of the MEDLINE database from 1966 to January 2001 by using individual syndromes and their hallmark symptoms as search terms.
Study Selection: Studies that assessed patients with at least one unexplained clinical condition and that included information on symptoms, overlap with other unexplained clinical conditions, or physiologic markers. Conditions examined were the chronic fatigue syndrome, fibromyalgia, the irritable bowel syndrome, multiple chemical sensitivity, temporomandibular disorder, tension headache, interstitial cystitis, and the postconcussion syndrome.
Data Extraction: Information on authorship, patient and control groups, eligibility criteria, case definitions, study methods, and major findings.
Data Synthesis: Many similarities were apparent in case definition and symptoms, and the proportion of patients with one unexplained clinical condition meeting criteria for a second unexplained condition was striking. Tender points on physical examination and decreased pain threshold and tolerance were the most frequent and consistent objective findings. A major shortcoming of all proposed explanatory models is their inability to account for the occurrence of unexplained clinical conditions in many affected patients.
Conclusions: Overlap between unexplained clinical conditions is substantial. Most studies are limited by methodologic problems, such as case definition and the selection and recruitment of case-patients and controls.
Author and Article Information
Acknowledgments: The authors thank Drs. Kurt Kroenke and Jack Goldberg for their helpful comments on several versions of this paper.
Requests for Single Reprints: Leslie Aaron, PhD, MPH, Department of Medicine, Division of Internal Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104; e-mail, laaron{at}u.washington.edu.
Current Author Addresses: Drs. Aaron and Buchwald: Department of Medicine, Division of Internal Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104. RESEARCH AND MEASUREMENT ISSUES
A Review of the Evidence for Overlap among Unexplained Clinical Conditions
This article has been cited by other articles:
|
|
 |
|
  K. A. Leiknes, A. Finset, T. Moum, and I. Sandanger Overlap, Comorbidity, and Stability of Somatoform Disorders and the Use of Current Versus Lifetime Criteria Psychosomatics, April 1, 2008; 49(2): 152 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Wingenfeld, C. Heim, I. Schmidt, D. Wagner, G. Meinlschmidt, and D. H. Hellhammer HPA Axis Reactivity and Lymphocyte Glucocorticoid Sensitivity in Fibromyalgia Syndrome and Chronic Pelvic Pain Psychosom Med, January 1, 2008; 70(1): 65 - 72. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. A. Kanaan, J. P. Lepine, and S. C. Wessely The Association or Otherwise of the Functional Somatic Syndromes Psychosom Med, November 1, 2007; 69(9): 855 - 859. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Sumathipala What is the Evidence for the Efficacy of Treatments for Somatoform Disorders? A Critical Review of Previous Intervention Studies Psychosom Med, November 1, 2007; 69(9): 889 - 900. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Tietjen, J. L. Brandes, K. B. Digre, S. Baggaley, V. T. Martin, A. Recober, L. O. Geweke, F. Hafeez, S. K. Aurora, N. A. Herial, et al. History of childhood maltreatment is associated with comorbid depression in women with migraine Neurology, September 4, 2007; 69(10): 959 - 968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kroenke, M. Sharpe, and R. Sykes Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations Psychosomatics, August 1, 2007; 48(4): 277 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Osterberg, R Persson, B Karlson, F C. Eek, and P Orbaek Personality, mental distress, and subjective health complaints among persons with environmental annoyance Human and Experimental Toxicology, March 1, 2007; 26(3): 231 - 241. [Abstract] [PDF]
|
|
|
|
|
|
G. E. Tietjen, J. L. Brandes, K. B. Digre, S. Baggaley, V. Martin, A. Recober, L. O. Geweke, F. Hafeez, S. K. Aurora, N. A. Herial, et al. High prevalence of somatic symptoms and depression in women with disabling chronic headache Neurology, January 9, 2007; 68(2): 134 - 140. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Fink, T. Toft, M. S. Hansen, E. Ornbol, and F. Olesen Symptoms and Syndromes of Bodily Distress: An Exploratory Study of 978 Internal Medical, Neurological, and Primary Care Patients Psychosom Med, January 1, 2007; 69(1): 30 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Azziz, E. Carmina, D. Dewailly, E. Diamanti-Kandarakis, H. F. Escobar-Morreale, W. Futterweit, O. E. Janssen, R. S. Legro, R. J. Norman, A. E. Taylor, et al. Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4237 - 4245. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D T Stephenson and J R Price Medically unexplained physical symptoms in emergency medicine. Emerg. Med. J., August 1, 2006; 23(8): 595 - 600. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Wearden and C. Chew-Graham Managing chronic fatigue syndrome in UK primary care: challenges and opportunities Chronic Illness, June 1, 2006; 2(2): 143 - 153. [Abstract] [PDF]
|
|
|
|
|
|
R. Moss-Morris and M. Spence To "Lump" or to "Split" the Functional Somatic Syndromes: Can Infectious and Emotional Risk Factors Differentiate Between the Onset of Chronic Fatigue Syndrome and Irritable Bowel Syndrome? Psychosom Med, May 1, 2006; 68(3): 463 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Blanchard, S. A. Eisen, R. Alpern, J. Karlinsky, R. Toomey, D. J. Reda, F. M. Murphy, L. W. Jackson, and H. K. Kang Chronic Multisymptom Illness Complex in Gulf War I Veterans 10 Years Later Am. J. Epidemiol., January 1, 2006; 163(1): 66 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R E Clouse and P J Lustman USE OF PSYCHOPHARMACOLOGICAL AGENTS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS Gut, September 1, 2005; 54(9): 1332 - 1341. [Full Text] [PDF]
|
|
|
|
|
|
J. E. Broderick, D. U. Junghaenel, and J. E. Schwartz Written Emotional Expression Produces Health Benefits in Fibromyalgia Patients Psychosom Med, March 1, 2005; 67(2): 326 - 334. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Gallagher, J. M Thomas, W. T Hamilton, and P. D White Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001 J R Soc Med, December 1, 2004; 97(12): 571 - 575. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. C. Lin Small Intestinal Bacterial Overgrowth: A Framework for Understanding Irritable Bowel Syndrome JAMA, August 18, 2004; 292(7): 852 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Tan, K. Tillisch, and E. Mayer Functional Somatic Syndromes: Emerging Biomedical Models and Traditional Chinese Medicine Evid. Based Complement. Altern. Med., June 1, 2004; 1(1): 35 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Mayou, J. Levenson, and M. Sharpe Somatoform Disorders in DSM-V Psychosomatics, December 1, 2003; 44(6): 449 - 451. [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Chester Symptoms of Rhinosinusitis in Patients With Unexplained Chronic Fatigue or Bodily Pain: A Pilot Study Arch Intern Med, August 11, 2003; 163(15): 1832 - 1836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Henningsen, T. Zimmermann, and H. Sattel Medically Unexplained Physical Symptoms, Anxiety, and Depression: A Meta-Analytic Review Psychosom Med, July 1, 2003; 65(4): 528 - 533. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Croft Symptoms without pathology: should we try a little tenderness? Rheumatology, July 1, 2003; 42(7): 815 - 817. [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Gold, F. Dipalo, M. S. Gold, and D. O'Hearn The Symptoms and Signs of Upper Airway Resistance Syndrome: A Link to the Functional Somatic Syndromes Chest, January 1, 2003; 123(1): 87 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Allen, J. I. Escobar, P. M. Lehrer, M. A. Gara, and R. L. Woolfolk Psychosocial Treatments for Multiple Unexplained Physical Symptoms: A Review of the Literature Psychosom Med, November 1, 2002; 64(6): 939 - 950. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Hassett and L. H. Sigal Unforeseen Consequences of Terrorism: Medically Unexplained Symptoms in a Time of Fear Arch Intern Med, September 9, 2002; 162(16): 1809 - 1813. [Full Text] [PDF]
|
|
Article
