LAUSR

Persistent physical symptoms are common and include those symptoms that last at least three months and are insufficiently explained by a medical condition after adequate examination and investigation. 2 Examples include unexplained abdominal pain, musculoskeletal pains, fatigue, headache and dizziness. These symptoms are often associated with functional impairment and psychological distress among patients, and increase healthcare costs. Observational studies in primary care report that women, especially those aged 35-45 years, more commonly present with these symptoms. 5 Defining and categorising an unexplained symptom is tricky and disputed (see box 1). 10 Sometimes symptoms fit criteria for somatoform or psychiatric disorders set out in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) or functional somatic syndromes such as irritable bowel syndrome. In other cases there is no label to offer the patient. Several pharmacological and psychological interventions have been studied for somatoform disorders, but evidence on their effectiveness is limited and of poor quality. What is the evidence of uncertainty?