Subjective medical conditions

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Symptoms, which have been labelled by a medical practitioner, generally using a descriptive diagnostic label, which are disproportionate to, or are not supported by, objective evidence of a physical or psychiatric condition.

The symptoms are common and non-specific, they generally include one or more of the following:

• Pain
  • Myofascial (joints and soft tissues)
  • Joint pain
  • Back pain
  • Headache
• Fatigue
• Cognitive impairment (such as disturbance of memory or concentration)
• Disordered sleep
• Disorders of mood (depression/anxiety)
• Bowel symptoms (such as frequency, loose motions or discomfort)

Many people experience these common symptoms, however few identify themselves as "sick" or "disabled" - thus coming to the attention of medical practitioners and insurers.

Contents 1 Examples of these conditions 2 History 3 Aetiology 4 Medical and behavioural issues 5 Management

[edit] Examples of these conditions

• Psychiatric conditions
  • Pain disorders (sometimes referred to as "chronic pain syndromes")
  • Other somatoform disorders
• Other conditions
  • Chronic fatigue syndrome (CFS)
  • Fibromyalgia
• Certain "toxic" conditions
  • "Sick building syndrome"
  • "Multiple chemical sensitivity"
  • "Gulf war syndrome"
• Some chronic musculoskeletal conditions
  • "Whiplash"
  • Repetitive strain injury
  • Chronic back pain

[edit] History

These conditions have been recognised for some time (for example "neurasthenia", described in 1869, has features which we would currently label as "chronic fatigue syndrome")

[edit] Aetiology

By definition, there is no identified biological cause for the symptoms described by the subject. Using a bio-psycho-social approach in attempting to understand this situation; yields a number of possible reasons, namely:

A. Early or undifferentiated general medical condition (these generally "declare" themselves in time)

B. Psychiatric conditions

• Somatoform disorders
• Factitious disorder

C. Malingering

[edit] Medical and behavioural issues

Although no primary pathological process is identified in these conditions, sufferers frequently receive unproven biologically-based treatments. In addition, secondary maladaptive behavioural issues can develop in which the sufferer avoids activity believed to increase symptoms. This avoidant behaviour can result in adverse secondary problems such as deconditioning. Biologically-based medical treatment often reinforces this maladaptive and avoidant behaviour.

[edit] Management

Paramount is managing people with these symptoms is avoiding the process of labelling. The application of a formal diagnostic label, reinforces the concept of a biological illness. Descriptive diagnostic labels (such as "chronic fatigue syndrome" and "fibromyalgia") tend to imply an underlying biological basis.

The management of these conditions generally involves simple symptomatic management (for example use of simple analgesia to treat pain and tri-cyclic antidepressants to treat sleep disturbance).

Maladaptive avoidant behaviour is managed using a cognitive-behavioural approach in conjunction with a graded exercise or activity program.

Although, many suffers have evidence of psycho-social problems, formal psychological or psychiatric intervention is required in a minority of cases. Of course, as certain of these individuals will later go on to develop a fully evolved general medical condition, regular medical surveillance is generally required.

These individuals should generally be encouraged to maintain, where possible, normal personal, social, domestic and occupational activities.