Von Korff and colleagues report findings from a clinical trial evaluating a stepped-care approach to back pain. Finally, in what prove to be companion papers, Katon examines psychiatric comorbidity in patients with physical symptoms and Sharpe describes a psychological paradigm to enhance care. Only about half of all symptoms evaluated in primary care have a discrete physical cause, and at least one third are medically unexplained. In such cases, depressive, anxiety, or somatoform disorders are commonly present and can be effectively treated. These papers are intended to serve as an introduction and a stimulus to the field of symptoms research.
Some topics are noticeably absent.
For example, chest pain has been the subject of superb clinical studies, although these have enlightened us more about cardiac than noncardiac causes. We have not reviewed the extensive literature on pain. Clinical studies predominate over the basic sciences. Both are desperately needed, along with collaboration with social scientists, to populate the frontiers of symptoms research. This preface concludes where it began with the experience of headache.