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What are Unexplained Chronic Medical Symptoms?

At least 35% of people at some point have physical problems that are unexplained despite seeing their doctor. Most of these are temporary and go away on their own (Steinbrecher, 2011).

As many as 3% of people may suffer from persistent physical symptoms which are not life-threatening, but there is also not any obvious cause (Steinbrecher, 2011).

What Causes It?

There are many theories on why some people have problems with unexplained chronic symptoms:

• Heightened sensitivity: Some people are simply more sensitive to physical sensations, and may be more aware of physical signals that other people are simply not aware of.
• Stress: Some people may be under the effects of chronic stress. Chronic stress can cause all manner of physical and emotional symptoms, including low energy, headaches, stomach complaints, chest pain, troubles sleeping, and frequent infections. Typical stresses include work, family, and relationships.
• Tendency to want to avoid conflict: Some people have the strength of being kind and considerate, and are able to forego their own needs and wishes, deferring to others. Unfortunately, when a person ignores their own needs excessively, it can cause built up stress.
• Family history: Sometimes these conditions can run in families.

How Do I Cope?

The good news is that there are many things you can do:

• Recognize that you have stresses in your life -- like everyone does.  Everyone has stresses, such as home stress (such as relationships, kids, finances), work stress (such as the work itself, co-workers/bosses) and school stress (such the academic work, and fellow students/teachers). Some people try to ignore and deny that they have stresses. Unfortunately, as far as your body is concerned, it still feels the stress. Stress that builds up in your body can worsen your medical symptoms.
  
  It can be helpful to:
  a) Acknowledge that you have stresses.
  b) Identify what stresses you have -- is it home? Work? School? Relationships? 
  c) Come up with a plan to cope with each possible stress. 
   

• Find meaning in your life rather than happiness. Because many people in modern societies search for happiness, you may see your medical symptoms as an obstacle to happiness. Paradoxically however, the constant search for happiness itself can be a barrier for happiness.
  
  “It is the very pursuit of happiness that thwarts happiness.” – Viktor Frankl
  
  People who are self-focused on making themselves “happy” (such as from having pleasurable experiences such as going out and watching movies), but who have little-to-no sense of meaning, are not truly happier. On the other hand, studies show that you will feel happier if you feel connected to something greater than yourself such as:

  • Helping or contributing to others such as family, pets, animals, the environment, the planet, those less fortunate, etc...  

  • Being part of a religious community

If you can find some meaning, some orientation to something bigger than yourself, then you will be closer to feeling genuine happiness…

“Be in the present moment, be open and curious, and devote your life to what matters. Do this and you are liable to catch happiness along the way.” – Dr. T. Kashdan

• Spend positive time with family and friends. Human beings are a social species, and having good relationships with one another is good for both our emotional and physical health. If you find that there are disagreements or conflicts getting into the way of your relationships, then speak with your primary care provider on how to cope or get help.
   

• Share how you feel with supportive friends and family. Many people, particularly men, have been conditioned to keep their stresses and emotions inside. Or you may have learned from past experiences that sharing with others hasn’t been helpful. The truth however, is that as human beings, we are hard-wired to have emotions and to be social. It is in fact, these abilities that have made us the dominant species on this planet. No matter how much we may try to suppress this, the inescapable fact is that all of us are emotional beings that 1) have feelings and 2) feel a need to feel accepted by others. Let them know that you don’t need them to give advice or fix your issue, but to just listen and be there for you.
  
  For example, you might say: “Can we talk? I just need you to listen. You don’t have to feel like you have to give me any advice or anything like that; it helps me just to know that you are listening.”
   

• Don’t just complain about your symptoms. When you do talk with a loved one, try not to just focus on your symptoms, but just talk about your feelings. For example, if you have chronic abdominal pain, it is better to not excessively complain about the pain, but rather let a loved one know that you are feeling frustrated and that it’d be nice to just sit with them for a few minutes together.
   

• Practice self-compassion. How do we treat a loved one who is suffering? With kindness, compassion and acceptance. How do people treat themselves when they are suffering? Often times, we treat ourselves with an inner critical voice, such as feeling blame, guilt, shame or non-acceptance. The solution is self-compassion, practiced for millennia by humankind -- because for most of human history, there has been great suffering, with much less medical knowledge than nowadays. Self-compassion offers a powerful way to cope with human suffering, including unexplained, chronic medical symptoms.

General prevention and lifestyle habits:

• Get enough sleep: Sleep is restorative and this is particularly important if you have medical symptoms. Poor sleep can worsen medical symptoms such as chronic pain. Try to have a regular bedtime routine, followed by soothing activities in bed, such as reading or listening to calming music. Try to avoid looking at an electronic screen, as the light tricks your brain into thinking its daytime (by blocking melatonin production) and thus although entertaining, makes it harder to sleep.
   

• Eat a healthy diet: Try your best to eat a healthy diet with regular meals. If you have abdominal or digestive issues, consider speaking to your primary care provider or dietician for specific advice in your situation.
   

• Avoid alcohol and street drugs: In general it is best to avoid alcohol and street drugs.  Note that there are unique exceptions such as marijuana for certain types of chronic pain. If you are wondering if marijuana may be useful for you, speak to your primary care provider.
   

• Avoid smoking: As a general rule, avoiding smoking is important to prevent cardiovascular disease and cancer.
   

• Get regular exercise: Chronic pain can lead people to avoid exercise, however studies show that for chronic pain, even small amounts of regular physical activity can be helpful. Speak to your physician before starting any exercise program, in order to ensure it is okay in your situation. Going for walks with a family member or friend is one of the easiest ways to get started. Start with brief walks and gradually increase.

Family Support: What Can Friends and Family Do?

As a friend or family member, it can be frustrating when your loved one has chronic medical symptoms. The good news, is that there are many ways that you can support your loved one:

• Are you feeling frustrated at your friend or loved one? Its okay to feel frustrated. Underneath the frustration is probably sadness over a loss. Having a loved one with chronic medical symptoms is a bit of a loss -- you have lost the healthy person that you wished that s/he was. You may even need to grieve the loss -- cry the tears of loss, in order to grieve the loss of the healthy person that isn’t there anymore.

   
  
  

• Accept that you may not be able to change their medical situation, but at least you can offer your support and companionship so that they are not alone. Human beings can cope with all manner of medical distress, but being alone is the hardest.
   

• Listen, validate and accept how your loved one feels.

  • When your loved one talks about his/her issues, listen and accept that this is how they are feel, and express that you are grateful that they are sharing their concerns with you.
  • If he/she appears to be dwelling on their medical symptoms, then try to listen for the feelings underneath the complaints (e.g. frustration, anger, sadness, fear, loneliness). You might say, “Thank you for telling me about your back pain today. It sounds like its very frustrating.”
  • Validate and accept that they feel that way. You might say, “I can appreciate how you’d feel that way. It doesn’t sound easy.”
  • Ask them how you can be supportive. You might say: “How can I be helpful?” “What can I do to be supportive?”
     

• Do not judge, criticize, nor give advice unless it is asked for. Deep down, we all simply want to be accepted. Unfortunately, when we give unsolicited advice to another person, it can be misinterpreted as saying that we want them to change, and thus, that we do not accept them. It may seem paradoxical, but if you want your loved one to be more open to your advice, start by simply accepting them.
   

• Provide practical support by doing things together with your loved one, such as going shopping together, preparing meals together or doing chores together.

When to See a Doctor

Consider seeing your doctor if:

• You have new (‘acute’) medical symptoms that appear.  
• You notice significant changes in your old (‘chronic’) symptoms
• You are having problems coping. Whether your symptoms are new or old, if you are having significant problems coping (e.g. problems with depressed mood, anxiety or stress), see your doctor to help you cope. Your doctor may also  recommend seeing a professional with expertise in coping, such as an occupational therapist, psychiatrist or psychologist.

When you see your doctor, it helps to see the same person or team. With any complicated or chronic condition, it is helpful to have the same professional that gets to know you well, as opposed to going to seeing a different professional each time.

What Doesn’t Help

In general, pain killers (such as morphine) do not help. They may lead to temporary relief, but do not help in the long run. Worse, they can become habit-forming, which then leads to all manner of other problems.

Will It Get Better?

Most people who receive professional help to cope with the medical symptoms will benefit. In some cases, symptoms can disappear. Others may still have symptoms, but will be able to cope better.

Further Reading

Self-Help Readings

Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain, 2006, Joanne Dahl

Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy, 2005, Stephen Hayes

How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers, 2010, Toni Bernhard

References

Steinbrecher et al.: The prevalence of medically unexplained symptoms in primary care. Psychosomatics. 2011 May-Jun; 52(3):263-71.

Smith et al.: How do sleep disturbance and chronic pain inter-relate? Sleep Med Rev. 2004 Apr; 8(2): 119-32.

Kashdon T: The problem with happiness. Huffington Post, Sep 30, 2010. Retrieved May 2, 2015 from http://www.huffingtonpost.com/todd-kashdan/whats-wrong-with-happines_b_740518.html.

About This Document

Written by members of the Department of Medicine at the University of Ottawa, including Dr’s M. St-Jean (family physician), F. Motamedi (family physician), E. Wooltorton (family physician), K. Gillis (psychiatrist), D. Green (psychiatrist), M. Cheng (psychiatrist).

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from a health professional. Always contact a qualified health professional for further information in your specific situation or circumstance.

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