Editorial: Reconsidering Persistent Somatic Symptoms: A Transdiagnostic and Transsymptomatic Approach 2024 Löwe et al

Introduction

Regardless of cause, persistent somatic symptoms (synonymous with persistent physical symptoms) are distressing somatic complaints, which are present on most days for at least several months [1]. The term “persistent somatic symptoms” is therefore not linked to a specific cause of complaints; it is not a diagnosis, but a description of a condition based on clinical features. Persistent somatic symptoms, like any other symptoms, will always correspond to the subjective reality of the person experiencing them; no biomarker will be able to define this subjective experience. Although the term persistent somatic symptoms is aetiology-free in the literal sense, it is still very often misunderstood to be limited to functional somatic disorders, somatic symptom disorders, or so-called “medically unexplained symptoms,” the latter term in itself being highly problematic for both scientific and stigmatization reasons [2‒4]. This misunderstanding of persistent somatic symptoms reflects an unfortunate and scientifically outdated dualism of mind and body and does not do justice to the complexity and current scientific knowledge of symptom perception and biopsychosocial explanatory models. Of course, persistent somatic symptoms occur within somatic diseases, functional somatic disorders, mental disorders, and undiagnosed diseases [1]. In some cases, a somatic disease is the trigger for persistent somatic symptoms, which then may persist even after successful treatment of the somatic disease [5, 6].

Explanatory models for diverse persistent somatic symptoms such as pain, fatigue, gastroenterological, or neurological symptoms [1, 7, 8] have at least one feature in common: they usually involve biological, psychological, and social mechanisms and risk factors, i.e., they are biopsychosocial models. From this perspective, “transsymptomatically,” there are similarities but also differences in the postulated factors and mechanisms involved in the development of the various symptoms. Similarly, “transdiagnostically,” there are both commonalities and disease-specific factors and mechanisms for the development of the same persistent symptom in different diseases, such as fatigue in multiple sclerosis [9], post-stroke [10, 11], heart failure [12], inflammatory bowel disease [13], rheumatoid arthritis [14], or chronic fatigue syndrome [15]. In particular, factors of a psychosocial nature that contribute to symptom perception are likely to be common across diagnoses [1].

The aim of this editorial is to explore the possibilities of a transdiagnostic and transsymptomatic approach to persistent somatic symptoms, as based on the current state of science. The potential of such a transdiagnostic and transsymptomatic approach lies in achieving synergies in terms of science, understanding, and treatment of those affected.

Open access, https://karger.com/pps/article/doi/...5/Reconsidering-Persistent-Somatic-Symptoms-A

 

So, the very same stuff that has been asserted for decades and used in real life clinical practice on millions, to widespread failure. Here it's just a modest proposal. "Exploring" the idea. Anyway, has anyone tried handing the richest people in society huge tax cuts and fiscal loopholes, see if it somehow reduces poverty and grows the middle class? No one's ever thought of that before. Maybe we could explore the notion of having some sort of, monarch, perhaps, who could have the courage of making new laws by just saying so. Maybe, I don't know, have we tried killing the poor? Hey just exploring a modest never-tried-before proposal here.

Oh, and looky here, what if we did studies looking into those things? Why has no one ever done that before? Are they stupid?

The idea of generic treatments for common symptoms is as ridiculous as any gadget that claims to do everything (greases locks, entertains your children, sorts apples, lasers moles, walks your dog, makes perfect smoothies, grows your hair back, yes, this gadget can do all that!), or the ridiculous notion of a Skeleton key, this magical technology that gives people full access to any computer.

What if all grandmothers had wings and a jet engine? We could revolutionize air travel! And it would be carbon- and pollution-free! Imagine an entire society with free and nearly instant transport anywhere you want, all powered by grandmothers? Think of the potential here!

Also for curiosity, the references for "promising effectiveness of these approaches", published 2023 and 2024 because no one has ever tried that before, literally fell off the turnip truck yesterday, are:

The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trial
and
Effectiveness of a symptom-clinic intervention delivered by general practitioners with an extended role for people with multiple and persistent physical symptoms in England: the Multiple Symptoms Study 3 pragmatic, multicentre, parallel-group, individually randomised controlled trial