Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach [..] recovery, 2026, Abrahamsen+

[forestglip]

Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach to promote recovery

Spoiler: Authors

Abrahamsen, Cathrine; Beadsworth, Mike; Bostock, Will; Chalder, Trudie; Flottorp, Signe; Fors, Egil A.; Garner, Paul; Hadfield, Sarah; Kennedy, Becca; Kuehn, Rebecca; Landmark, Live; Launes, Gunvor; Liira, Helena; Linnestad, Lina; Rotkirch Virrantaus, Hélène; Vangelova-Korpinen, Velina

Background
A substantial proportion of people consulting primary care practitioners have symptoms that persist even after structural problems and diseases have been excluded. They experience distressing somatic complaints – such as fatigue, pain, headaches, and brain fog – lasting months or longer which impair quality of life and workability. In this article, we refer to these as persistent physical symptoms (PPS). When diagnosis, advice and care are based solely on a biomedical interpretation of symptoms, patients may not improve. This can result in repeated and often frustrating consultations and investigations.

Aim
To outline contemporary theories around PPS for general practitioners, and offer practical, evidence-informed pathways to use in primary care.

Methods
Narrative literature review and consensus development with experienced practitioners.

Synopsis
Contemporary theories Contemporary theories of PPS provide a coherent framework for understanding symptom persistence and guide treatment. These theories propose that symptoms may arise from brain-based responses to perceived threat, influenced by expectations and learned associations. Such responses can become unhelpful when benign sensations are interpreted as dangerous. Biopsychosocial factors unique to each individual influence these mechanisms which need to be considered when assessing PPS and working towards symptom resolution with the patient.

Evidence-informed pathways
Key strategies include validating patients’ symptoms and emotional experiences, providing clear explanations of symptom persistence, and developing personalised management plans that combine biological, psychological, and social approaches. Such strategies can reduce or resolve symptoms, foster hope and a sense of agency, and often lead to recovery.

Web | DOI | PDF | Scandinavian Journal of Primary Health Care | Open Access

 

[forestglip]

PPS include fatigue, exhaustion, pain, and sometimes digestive or specific functional neurological problems. Current diagnostic classifications do not correspond well with the contemporary scientific understanding of PPS, and this causes confusion. Groups of persistent symptoms may be labelled as conditions, and include myalgic encephalomyelitis/chronic fatigue syndrome, post-viral fatigue syndrome, post COVID-19 condition, fibromyalgia, irritable bowel syndrome, functional neurological disorders or environmental sensitivity. However, symptoms within these labels overlap and may evolve from one symptom profile to another over time [1,5-7]. A common element across all is the understanding that biological, psychological, and social factors influence these conditions.

 

[NelliePledge]

Ugh

 

[Jonathan Edwards]

It seems as if evidence-informed may be replacing evidence-based?

Why are there about thirty authors when a review paper like this can be written by one person?

 

[MrMagoo]

I feel like we need a “rage” scale as to how enraging the “average” forum member is likely to become from reading any given paper.

Whatever the top rating is, this qualifies.

 

[Jonathan Edwards]

A substantial proportion of people writing in primary care practitioner journals have symptoms that persist even after structural problems and diseases have been excluded. They experience distressing somatic complaints – such as encountering people with fatigue, pain, headaches, and brain fog – lasting months or longer which impair quality of life and work satisfaction. In this article, we refer to these symptoms as persistent biopsychosocial symptoms (PBS). When diagnosis, advice and care are based solely on a biomedical interpretation of these symptoms, authors may not improve. This can result in repeated and often frustrating discussions on patient forums.

 

[Joan Crawford]

"Contemporary theories of PPS provide a coherent framework for understanding symptom persistence and guide treatment. These theories propose that symptoms may arise from brain-based responses to perceived threat, influenced by expectations and learned associations."

Nought contemporary about this. Freud was hard at this a century ago.....

 

[Utsikt]

It looks like they are mostly citing their own opinion pieces, sometimes disguised as narrative reviews etc., and other similar publications by BPS proponents.

They cite Abrahamsen’s own ICIT articles (they are very flawed), Nerli that found that the intervention didn’t work even though they claimed success, Ursin’s central sensitisation study, Crawley’s review of LP, and Frisk’s study with no control arm.

If this is them displaying the best studies they’ve got, they really should be embarrassed. Perhaps some guided conversations can help extinguish their unhelpful beliefs in that they are actually scientists.

Brain retraining and Recovery Norway features:

Some patients benefit from specific brain retraining programmes; the Lightning Process has been evaluated in a small trial, and several trials in other packages are currently ongoing [Citation33]. Some of these programmes offer one-to-one support from a trained practitioner as part of follow-up care.

Case reports and case series, for example as documented on Recovery Norway, suggest some dramatic results of people with severe ME/CFS – bedbound and tube fed – who improved within a short period after participating in structured brain re-training programmes. More rigorous qualitative and quantitative evaluations are needed to inform policy and provide evidence-based guidance.

And it looks like Live Landmark forgot to disclose her conflict of interest wrt her LP courses. As well as Abrahamsen (she sells educational programmes to GPs etc with ICIT),

Disclosure statement​

No potential conflict of interest was reported by the author(s).

@dave30th something to notify the editors about?

 

[Joan Crawford]

....providing clear explanations of symptom persistence,"

How's that possible if the honest answer is that no one has much of a clue.

Duplicity mascarading as medical care.

 

[dave30th]

Nought contemporary about this. Freud was hard at this a century ago

Except that "brain-based responses" or "brain network" issues have replaced "psychological trauma" or "psychological issues" as the purportive causative factor. They're just exchanging one set of words with another to make it sound more scientific, but the lack of evidence for either "psychological issues" or "brain network" issues is glaring.

 

[dave30th]

@dave30th something to notify the editors about?

Hm. I'll take a look. thanks for the heads up!!

 

[dave30th]

How's that possible if the honest answer is that no one has much of a clue.

very similar to the claims in the paper to which we responded last year (or the year before?)--that a clear explanation was helpful.

 

[Turtle]

Authors:" Providing clear explanations of symptom persistance, benign sensations are interpreted as dangerous".
"Foster hope and a sense of agency often lead to recovery.

In my words: I am just very stupid and need to be taught sensations are ok, no danger of PEM.

For almost 35 years of waiting for a cure and the only thing that helps is hope?

A big bunch of simpletons, the authors I mean.

 

[Utsikt]

Case reports and case series, for example as documented on Recovery Norway, suggest some dramatic results of people with severe ME/CFS – bedbound and tube fed – who improved within a short period after participating in structured brain re-training programmes.

I just noticed that they claim that the self-reported stories on the Recovery Norway website are «case reports» or «case series». That’s really stretching it. And why don’t they mention the case series at lp-fortellinger?

More rigorous qualitative and quantitative evaluations are needed to inform policy and provide evidence-based guidance.

As usual, someone has to do better in the future. But they are convinced it works based on a few anecdotes, so there’s no need for proper trials assessing the intervention - all we need is to figure out how to roll it out most effectively.

Or as Landmark said was her goal many years ago - get the government to pay for the LP courses..

 

[rvallee]

A substantial proportion of people consulting primary care practitioners have symptoms that persist even after structural problems and diseases have been excluded

Russel's teapot is out there spinning in its orbital grave. This is medical fiction. It belongs next to books by Deepak Chopra, not an academic journal.

When diagnosis, advice and care are based solely on a biomedical interpretation of symptoms, patients may not improve

It was a (comically) big deal when the Catholic pope admitted he was not infallible. This is an assertion of omniscience and omnipotence, which even the Pope never did, always referring to his haloed buddy up there. Maybe they must have missed the entire Enlightenment because those arguments are completely unserious.

Contemporary theories of PPS provide a coherent framework for understanding symptom persistence and guide treatment. These theories propose that symptoms may arise from brain-based responses to perceived threat, influenced by expectations and learned associations.

They must have also missed intro to science, because none of those models are theories. They are just speculative models. Even framework is far above whatever this copy-paste junk is. Same old copy-paste junk. And people criticize LLMs for being plagiarizing machines. Ha!

Key strategies include validating patients’ symptoms and emotional experiences, providing clear explanations of symptom persistence, and developing personalised management plans that combine biological, psychological, and social approaches. Such strategies can reduce or resolve symptoms, foster hope and a sense of agency, and often lead to recovery.

Well, lying is indeed a strategy. It has no place in medicine (cough duty of candor cough), and this is exactly why. Also none of those are real skills that anyone is trained at.

When diagnostic test results reveal no structural disease, health care professionals may tell patients that ‘nothing is wrong’.

But this is just lying. Not knowing what is wrong and nothing being wrong are completely different things. This is something common in medicine. Oncologists never tell their patients the cancer is forever gone. All they can know is that it is no longer detectable. This isn't just failing at science and logic, it also fails at ethics, at medicine's own "duties", which is clearly a misnomer, and likely at several laws.

None of this has any actual evidence of efficacy though. This is what's commonly called evidence-based medicine, because George Orwell is also spinning in his grave.

Some patients benefit from specific brain retraining programmes; the Lightning Process has been evaluated in a small trial, and several trials in other packages are currently ongoing [Citation33]. Some of these programmes offer one-to-one support from a trained practitioner as part of follow-up care. Case reports and case series, for example as documented on Recovery Norway, suggest some dramatic results of people with severe ME/CFS – bedbound and tube fed – who improved within a short period after participating in structured brain re-training programmes. More rigorous qualitative and quantitative evaluations are needed to inform policy and provide evidence-based guidance.

Completely unserious. Zero difference between this and promoting Scientology. While one of the authors gets income from this, supported by the director of a national medical research institute. This is beyond appalling.

Some patients face complex barriers to recovery, such as severe early-life trauma, multiple comorbidities, or a strictly biomedical understanding shaped by prior healthcare experiences.

This is completely made-up. It can't be said enough that none of this has any validity. They are just straight up pulling things out of their collective asses.

The Consumer Advisory Group of the Collaborative of Fatigue and Related Symptoms Following Infection advised on this document’s outline and final draft, and we thank Fiona Symington for her advice. Four of the authors have experienced PPS and recovered.

This is an output of the Oslo Chronic Fatigue Consortium and abides by their authorship guidance, which aligns with ICMJE criteria.

They got the group back together, playing out the same old copies of old songs written before any of them were born. Even Scuba Paulie is there.

No potential conflict of interest was reported by the author(s).

There is clearly a major problem with how ethics evaluations are performed. Or not performed, I guess.

It seems as if evidence-informed may be replacing evidence-based?

Why are there about thirty authors when a review paper like this can be written by one person?

A bar already so low that corpses keep crawling over it was lowered further. At this point traffic around this point consists mainly of worms and dirty water.

If this is them displaying the best studies they’ve got, they really should be embarrassed. Perhaps some guided conversations can help extinguish their unhelpful beliefs in that they are actually scientists.

It really is. This is what's so stunning about this. Everything they refer to here is the most cherry-picked of all cherries, the best of their best, and it's worth absolutely nothing. This is after a solid 4 decades of promoting, marketing, trialling and deploying this onto millions. This is the absolute best that this ideology can come up with after all this time. Which is identical to the first versions. You could not catch me dead crawling over their bar and putting my name onto something this mediocre in any context. There is no amount of money you could pay me to have my name attached to this. Seriously. Try me.

Except that "brain-based responses" or "brain network" issues have replaced "psychological trauma" or "psychological issues" as the purportive causative factor. They're just exchanging one set of words with another to make it sound more scientific, but the lack of evidence for either "psychological issues" or "brain network" issues is glaring.

It's not a pyramid scheme. It's clearly a reverse funnel.