Approach to the Patient with Multiple Somatic Symptoms

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Key points

  • Patients with multiple and persistent physical symptoms are common in primary care.

  • Collaboration with the patient is critical for effective management. Patients should be actively involved in setting treatment goals and deciding among therapeutic options.

  • Screening and treatment of depression and anxiety disorders is a key component of management. Patients should be educated about how psychosocial stressors and somatic symptoms interact.

  • Somatization can occur among patients with chronic medical

Spectrum of severity of somatic symptoms: a biopsychosocial approach to diagnosis and management

The 3 common types of somatization seen in primary care and management approaches to patients with these varying types of somatization are described in Box 3.

  • 1.

    In primary care settings, it is common for patients to present with somatic symptoms related to temporary stressors. For example, symptoms such as headache or back pain could be triggered or amplified in the context of a job loss, divorce, or interpersonal difficulties. Resolution of these acute somatic symptoms requires minimal treatment

Psychiatric disorders among patients with somatic symptoms

Up to 20% of patients presenting for a primary care visit report significant depressive symptoms, and 5% to 10% meet diagnostic criteria for major depression.39 Depression is characterized by changes in mood accompanied by somatic and cognitive changes.16 When patients with depression seek care from their health care provider, their chief complaint is often somatic rather than emotional.40 In an international multicenter study of more than 1000 patients,7 69% of patients with depression

Management recommendations

Our approach to management of patients with somatic symptoms is based on the effective methods supported by published evidence and also on our experience working with primary care providers. First, an overview is presented of general strategies, and then, specific recommendations tailored to the severity of the patient’s symptoms and comorbidities are made.

Summary

In primary care settings, patients frequently present with multiple somatic complaints, which can be associated with significant distress and functional impairment. When these somatic complaints are related to acute psychosocial stressors, the somatic symptoms resolve relatively rapidly in most cases, usually without any specific treatment. However, in 20% to 25% of cases, these symptoms can recur or become chronic and can be associated with high use of medical services and increased risk of

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    Disclosures: None of the other authors has conflicts of interest to report.

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