Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Lancet. 2024 Jun 15;403(10444):2649-2662. doi: 10.1016/S0140-6736(24)00623-8.
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.
持续的身体症状（与持续的躯体症状同义）是一个总括性术语，用于描述持续数月或更长时间的令人痛苦的躯体抱怨，无论其原因如何。这些症状与严重的残疾有关，给患者、医疗保健专业人员和社会带来了重大负担。持续的身体症状可能是由感染、损伤、医学疾病、压力生活事件引起的，也可能是新出现的。随着症状的持续存在，其与明确可识别的病理生理学的联系往往会减弱，从而使诊断和治疗变得具有挑战性。多种生物和心理社会风险因素和机制导致躯体症状的持续存在，包括持续的炎症；表观遗传特征；免疫、代谢和微生物失调；早期不良生活经历；抑郁；与疾病相关的焦虑；功能失调的症状预期；症状关注；症状学习；和回避行为，许多因素在症状和诊断中是共同存在的。基本护理包括解决潜在的病理生理学问题，并使用以患者为中心的沟通技巧，包括验证、适当的保证和身心社会解释。如果基本护理不足，针对性的心理和药物干预可能会有所帮助。更好地了解躯体症状的多因素持续存在，应该会导致更具体、个性化和基于机制的治疗，并减少患者普遍面临的污名。
