Medically Unexplained Symptoms

Guidance for commissioners of services for people with medically unexplained symptomsThis guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.

MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.

This guide aims to:

  • describe MUS and the associated outcomes
  • outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and
  • highlight the importance of commissioning comprehensive MUS services.

Download Guidance for commissioners of services for people with medically unexplained symptoms

By the end of this guide, readers should be more familiar with the concept of MUS services and better equipped to understand:

  • the nature of MUS and the effects these illnesses have on physical, psychological and social functioning
  • the particular aspects of MUS which can affect engagement, response to treatment and outcomes
  • the severity of MUS and the necessity for comprehensive specialist treatment
  • the key components of a comprehensive MUS service, including the range of treatments and professional groups that should be available to patients with MUS
  • the need for highly integrated services and comprehensive care pathways to ensure the safe and effective management of patients across the spectrum of severity of MUS, and
  • the risk to patients with MUS if commissioning of MUS services is not clinically informed and subject to ongoing dialogue between commissioners, service providers, patients and carers.

Ten key messages for commissioners

  1. The term Medically Unexplained Symptoms (MUS) refers to persistent bodily complaints for which adequate examination does not reveal suf cient explanatory structural or other speci ed pathology
  2. These symptoms are common, and are presented in various degrees of severity in all areas of the healthcare system.
  3. MUS accounts for approximately 10% of total NHS expenditure on services for the working age population in England.
  4. Many people with MUS have complex presentations caused, or exacerbated, by co-morbid mental health problems such as anxiety, depression or personality disorders.
  5. Patients are often subjected to repeated diagnostic investigations, and unnecessary and costly referrals and interventions.
  6. Without appropriate treatment, outcomes for many patients with MUS are poor. While evidence-based treatments for patients with MUS exist, they are rarely available.
  7. Appropriate services for people with MUS should be commissioned in primary care, community, day services, accident and emergency (A&E) departments and inpatient facilities. This would enable patients to access services that are appropriate for the severity and complexity of their problems.
  8. In addition to a range of MUS services, a new kind of multidisciplinary approach is required, bringing together professionals with skills in general practice, medicine, nursing, psychology/psychotherapy, psychiatry, occupational therapy and physiotherapy. All healthcare professionals should integrate both physical and mental health approaches in their care.
  9. Education and training are essential to ensure that all healthcare professionals develop and maintain the skills to work effectively with patients experiencing MUS.
  10. Implementation of appropriate services would result in improved outcomes for patients and substantial cost-savings for the healthcare system.