
Healthdirect Australia is a useful website for information on chronic pain and other somatic complaints. Visit http://www.healthdirect.gov.au
General practitioners commonly encounter individuals who display excessive concern with a health complaint or physical symptoms that have no readily evident organic cause. These presentations can lead to a diagnosis of a somatic symptom disorder (previously known as somatoform disorders).
The category of somatic symptom disorder includes a range of clinical presentations such as:
Common to all these conditions is the central place of somatic symptoms in the presenting problem. Along with cognitive distortions and/or excessive thoughts, feelings and behaviours related to these physical complaints.
For example, a veteran may present with multiple physical symptoms that medical investigations fail to explain. He or she may report disproportionate concerns about the seriousness of those symptoms, along with a tendency to devote excessive time and energy to behaviours associated with them. It is important to note that:
The boundary between physical and mental health can be difficult to determine. As a general rule, a veteran’s physical complaints should be considered as part of a mental health diagnosis when all the following are present:
There are no well-established and widely accepted measures to screen for somatic symptoms and related disorders. However, the following questions adapted from the Mini International Neuropsychiatric Interview (MINI) may help identify veterans with a problem in this area:
Assess further if the client:
The Patient Health Questionnaire-15 (PHQ-15) is a tool for assessing the presence and severity of somatic symptoms.
In all assessments, practitioners need to be alert to the common comorbidity of mental health problems in veterans presenting with somatic complaints.
There has been little advance in the understanding of somatic symptom disorders or their treatment over the past 20 years. To date, there is insufficient evidence from the research literature to make firm recommendations for the treatment of somatic symptom disorders. Many veterans with somatic symptom disorders will be primarily treated by their general practitioners. Recommended management principles are listed below:
There is no current consensus on the best psychological treatments for somatic symptom disorders as there have been insufficient studies to warrant a meta-analysis. However, a review of the published studies has found that cognitive behavioural therapy (CBT) appears to be the most promising psychological approach for managing health anxiety, somatic symptoms, and pain (Jing et al., 2019). Although several variations of CBT have been employed, two elements are common to all:
In research studies, CBT treatment for somatic symptom disorders varies between 6 and 16 sessions. However, reviews have suggested that CBT is most effective with 10 or more sessions (Jing et al., 2019). Treatments may occur on an individual or group basis. There is evidence that group-based CBT programs may result in greater reductions in somatic symptoms compared to individual treatment (Jing et al., 2019). Hospitalisation should be avoided.
While undergoing more targeted psychological intervention it is also important to encourage the veteran to do the following:
Pain management programs (PMPs) are the treatment of choice for veterans suffering from chronic pain syndromes, including somatoform pain disorders. Effective PMPs adopt an explicit biopsychosocial model embedded within a cognitive behavioural paradigm, and include the following elements:
PMPs typically occur in a group setting and vary from two to six weeks duration.
Given the lack of firm evidence for the efficacy of pharmacological interventions, CBT should be considered the first-line treatment for somatic symptom disorders. However, medication may be beneficial for veterans who:
In cases where medication is considered necessary, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are the preferred first-line treatment (Kleinstäuber et al., 2014). Veterans with predominant pain symptoms may also respond to anticonvulsants, such as gabapentin (e.g. Neurontin) or pregablin (e.g. Lyrica).
Healthdirect Australia is a useful website for information on chronic pain and other somatic complaints. Visit http://www.healthdirect.gov.au