Medically unexplained physical symptoms
- See also: Somatoform disorder
Medically unexplained physical symptoms or MUPS is a term used in health care to describe a situation where an individual suffers from multiple physical symptoms for which the physician or other healthcare provider has found no physical cause. Up to 30% of all primary care consultations are patients with medically unexplained symptoms.
History and usage
The term medically unexplained physical symptoms was first used in 1987 by D.I. Melville.
MUPS is not synonymous with somatoform disorders such as somatization disorder where the cause or perception of symptoms is mental in origin. Instead, MUPS refers to the clinical situation where the cause of the symptoms cannot be determined, but might include somatic, physical or environmental causes.
However, several definitions of both somatization and MUPS exist, and the usage of both terms is not consistent in medical literature and practice. MUPS is sometimes used interchangeably with both somatization and functional somatic symptoms. 
Clustering of illnesses such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, chronic tension headache, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and posttraumatic stress disorder, suggests a common, but not understood, underlying cause.
The more different symptoms are present, the more likely is underlying psychiatric illness.
Environmental influences are suggested by the association between major life stresses and somatic symptoms.
The associations between psychological stress and medical illnesses may be due to either subtle physiological changes induced by the stress, or may be due to the stress leading to increased seeking of medical care.
The lack of etiology diagnosis in MUPS cases can lead to conflict between patient and health-care provider over the diagnosis and treatment of MUPS. This conflict can occur in the public arena and may involve media controversy, advocacy groups, scientific and political debate and even legal proceedings .
Diagnosis of MUPS is seldom a satisfactory situation for the patient, as many patients feel this implies it is "all in their head." This can lead to an adversarial doctor-patient relationship, which can develop into an iatrogenic neurosis, thus complicating the situation.
An empathetic approach by the doctor leading to a successful physician-patient relationship may be helpful. A randomized controlled trial found improvement using multi-faceted, collaborative care.
Consultation, in the form of a consultation letter from a psychiatrist or a joint consultation with the patient and both the psychiatrist and physician may help according to the Cochrane Collaboration. 
The use of diagnostic tests for reassurance is unclear with some studies reporting benefit among patients with chest pain in the emergency room and no benefit among outpatients with unexplained symptoms.
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