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Management of functional somatic syndromes
Peter Henningsen1, Stephan Zipfel, Wolfgang Herzog
1Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Langerstrasse 3, 81675 Munich, Germany. p.henningsen@tum.de
Lancet (London, England)
|March 21, 2007
Summary
Effective management of functional somatic syndromes (FSS) requires a stepped care approach. Active patient participation in treatments like exercise and psychotherapy is more beneficial than passive interventions for these complex psychosomatic conditions.
Area of Science:
- Psychosomatic Medicine
- Clinical Psychology
- General Practice
Background:
- Functional somatic syndromes (FSS) exhibit significant overlap but lack unified diagnostic criteria, hindering cross-specialty research and treatment.
- Current treatment research predominantly focuses on individual syndromes, neglecting the broader spectrum of FSS.
Purpose of the Study:
- To review management strategies for the full spectrum of FSS based on systematic reviews and meta-analyses since 2001.
- To propose a stepped care model differentiating between uncomplicated and complicated FSS.
- To provide evidence-based recommendations for managing FSS.
Main Methods:
- Systematic review and meta-analysis of treatment research for FSS published since 2001.
- Analysis of non-pharmacological and pharmacological treatment efficacy.
- Evaluation of different therapeutic approaches (biomedical, organ-oriented, cognitive-interpersonal).
Main Results:
- Non-pharmacological treatments requiring active patient engagement (e.g., exercise, psychotherapy) are more effective than passive physical measures.
- Pharmacological agents acting on the central nervous system (CNS) demonstrate more consistent efficacy than those targeting peripheral dysfunction.
- A balanced approach integrating biomedical, organ-oriented, and cognitive-interpersonal strategies is optimal for FSS.
Conclusions:
- A stepped care approach is recommended for managing functional somatic syndromes, distinguishing between uncomplicated and complicated cases.
- Active, patient-centered non-pharmacological interventions and CNS-acting medications are key therapeutic components.
- Addressing the iatrogenic component and focusing on the doctor-patient relationship are crucial for successful FSS management.
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