How to manage medically unexplained symptoms (MUPS) in primary care
This article describes some common approaches for a GP (or other primary care health professionals) to manage medically unexplained physical symptoms (MUPS).
Validation
- Acknowledge that the symptoms are real and distressing
- Explain that although the symptoms are real, a full assessment – history, examination, investigations (see below) and specialist referral if necessary – has been made and no medical cause found
- Acknowledge that medicine has limits and the uncertainty is frustrating.
Explanation
- Consider (and record) physical, psychiatric and psychosocial diagnoses and symptoms
- Provide an explanation for symptoms, and craft explanations that include the body and the mind
- Always consider the role of past or current trauma, psychosocial stress and personal vulnerabilities.
Symptom management
- Offer symptom relief and practical support to address disability (e.g. home help, workplace assessment)
- Encourage physical therapies (e.g. massage, physiotherapy, hydrotherapy)
- Manage comorbidities as effectively as possible
- Broaden the agenda beyond physical symptom management
- Address healthy lifestyle goals – individual and team sport and activities (music etc).
Psychological care
- Encourage this to address the impact of illness and underlying issues that may exacerbate symptoms
- Consider referral to IAPT (NHS counsellor) or liaison psychiatry
- Consider anti-depressants etc.
Coordination of care and harm reduction
- Coordinate care to avoid duplication of investigations that may lead to iatrogenic harm
- Repeat examination if required, even if not normally indicated.
Other principles
- Check for new diagnoses when the illness changes significantly (e.g. the emergence of a new symptom) or during a yearly health check
- Adopt a ‘caring’ not ‘curing’ approach. Use empathy
- Manage the therapeutic relationship carefully and seek support if it becomes unhelpful. And try to avoid a dependent relationship. For example, limit the number of patent contacts with an individual doctor.
Summary
We have described how to manage medically unexplained symptoms (MUPS) in primary care. We hope it has helped you.
