Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Fam Pract. 2011 Aug;28(4):444-55. doi: 10.1093/fampra/cmr004. Epub 2011 Mar 2.
The feasibility as well as the suitability of several therapies for medically unexplained symptoms (MUS) in primary care applied by the family physician (FP) appeared to be low. FPs need effective and acceptable strategies to manage these functionally impaired patients.
To review important and effective elements in the treatment of patients with MUS in primary care according to experts in MUS research.
We performed a systematic search of narrative reviews and scientific editorials in Medline and PsycINFO and triangulated our findings by conducting a focus group with MUS experts.
We included 7 scientific editorials and 23 narrative reviews. According to MUS experts, the most important elements in the treatment of MUS are creating a safe therapeutic environment, generic interventions (such as motivational interviewing, giving tangible explanations, reassurance and regularly scheduled appointments) and specific interventions (such as cognitive approaches and pharmacotherapy). Furthermore, MUS experts indicate that a multi-component approach in which these three important elements are combined are most helpful for patients with MUS. In contrast to most specific interventions, opinions of MUS experts regarding generic interventions and creating a safe therapeutic relationship seem to be more based on theory and experience than on quantitative research.
MUS experts highlight the importance of generic interventions and doctor-patient communication and relationship. However, studies showing the effectiveness of these elements in the management of MUS in primary care is still scarce. Research as well as medical practice should focus more on these non-specific aspects of the medical consultation.
家庭医生（FP）应用于初级保健的几种针对医学无法解释症状（MUS）的疗法的可行性和适用性似乎较低。FP 需要有效的、可接受的策略来管理这些功能受损的患者。
根据 MUS 研究专家，综述初级保健中治疗 MUS 患者的重要且有效的要素。
我们在 Medline 和 PsycINFO 中对叙述性综述和科学社论进行了系统检索，并通过与 MUS 专家进行焦点小组讨论来对我们的发现进行三角验证。
我们纳入了 7 篇科学社论和 23 篇叙述性综述。根据 MUS 专家的意见，治疗 MUS 最重要的要素是营造安全的治疗环境、采用常规干预措施（如动机访谈、提供具体解释、保证和定期预约）和具体干预措施（如认知方法和药物治疗）。此外，MUS 专家指出，将这三个重要要素结合起来的多组分方法对 MUS 患者最有帮助。与大多数具体干预措施不同，MUS 专家对常规干预措施和营造安全治疗关系的看法似乎更多地基于理论和经验，而不是定量研究。
MUS 专家强调了常规干预措施和医患沟通及关系的重要性。然而，在初级保健中管理 MUS 方面显示这些要素有效性的研究仍然很少。研究和医疗实践都应更多地关注医疗咨询的这些非特异性方面。
