Talk:Medically unexplained physical symptoms

message: 'Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored' A well known fact in the real world (though obviously not by doctors as it would appear). Perhaps someone else should go for full and proper sourcing etc.  — Preceding unsigned comment added by 82.75.140.248 (talk) 20:28, 6 September 2016 (UTC)

message: I removed:
:* NIH-funded studies are now underway to compare different treatment approaches for health anxiety and hypochondriasis:  a  study in the NYC area and a study in the Boston area.  In these studies, patients will be given one of four treatments: supportive therapy with fluoxetine, supportive therapy with placebo, cognitive behavior therapy, or cognitive behavior therapy with fluoxetine. For more information you can also visit external links.
from the external links, since it's to do with hypochondria, and not MUPS (unless you consider all MUPS to be hypochondria,) Herd of Swine 22:14, 23 April 2007 (UTC)
replies: text: Uh-oh. You named him without showing the dictated admiration... Guido den Broeder (talk) 07:16, 14 May 2008 (UTC)
thread_title:  I 

message: I removed the following from the article as being unreferenced:
:"One of the most widely-known promoters of the concept that these illnesses form a distinct and unitary category is Simon Wessley.  His work is highly controversial, has been the subject of a book, Denigration by Design, and has played a role in another book, Osler's Web.  The Countess of Mar has officially raised questions about his work."
Please do not restore this to the article without supplying a cite that supports it. -- 80.168.225.15 (talk) 08:11, 20 May 2008 (UTC)
replies: text: It was rather superfluous as Wessely's publications are already referenced to in the text. The controversial nature of his ideas is mentioned in the article Simon Wessely. Guido den Broeder (talk) 08:40, 20 May 2008 (UTC)
thread_title:  Removed from the article 

message: I found what appears to be a source for the dead link I just tagged here.  I'm a little confused as to where the statement that MUPS is most commonly associated with GWI comes from, though.  While I'll grant that "Gulf War Illness" is bolded within the text of table A-1, I believe that's solely because the appendix is based on military medicine, not because it's the most common term.  I see no indication that the bold is intended to indicate how common the term is.
Also, unless I've missed something here, I would suggest that we change the wording in the intro to include conditions that are not commonly linked.  Rightly or wrongly, CFS, Fibro, GWI, and MCS are often lumped together in peoples' minds (and sometimes in medical literature, etc.), but MUPS covers a much broader range than that as indicated by the table, including back pain, bladder symptoms, PMS, and a wide variety of other areas. --Rob (talk) 04:16, 11 July 2009 (UTC)
replies: text: The dead link should get replaced from a MEDRS, i agree, GWI is uncommon beside FM and CFS and IBS. There is alot of other MUPS like sick building syndrome and these can be added to article with MEDRS. RetroS1mone talk 13:49, 11 July 2009 (UTC)
replies: text: The material fails verification anyway,  The source doesn't say, "The term is commonly used to refer to Gulf War illness and more occasionally to other symptom-based diagnoses such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity."  The internet archives page lists the original link.   Ward20 (talk) 19:40, 11 July 2009 (UTC)
replies: text: No, it certainly doesn't say anything even remotely resembling that.  I think the original reference to GWI was only because it was bolded in the table in the document.  As I said above, I think we should probably incorporate a number of other examples from the table in the document.  Also, does anybody have any thoughts on what link we should use for the document?  Is the Internet Archive a suitable version, or should we go with the link I found (probably not the best choice), or something else entirely? --Rob (talk) 20:09, 11 July 2009 (UTC)
replies: text: I don't think any paticular illness should be described in the lead. It will only cause problems fighting over which ones should be stuffed in there. The lead should just describe the topic. Scanning the medically unexplained symptoms reviews on pubmend shows opinions about this entitiy are all over the place. Ward20 (talk) 22:51, 11 July 2009 (UTC)
replies: text: You've got a point there.  Maybe just change it to something like "a variety of conditions" or "a vast array of conditions" (though that last is perhaps less encyclopedic-sounding). --Rob (talk) 00:17, 12 July 2009 (UTC)
replies: text: I'm not sure the present source supports, "MUS is commonly used to refer to..." I don't see that validated in the abstract but I  haven't been able to review the whole article. Ward20 (talk) 03:44, 17 July 2009 (UTC)

text: Encyclopedia should give common examples. There is a way to say what ones are worth mentioning, it is which are more common and which are studied in the medical literature and which examples are in the medical literature. Ward 20 says, "I don't see that validated in the abstract" here is what abstract says, "Examples of syndromes consisting of MUPS include chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, somatoform disorders, and 'Gulf War Syndrome.'" Here is meta-analytic review of 244 studies, says four MUPS syndromes have enough studies for meta analysis, "irritable bowel syndrome (IBS), nonulcer dyspepsia (NUD), fibromyalgia (FM), and chronic fatigue syndrome (CFS)."  Another reivew in abstract, "MUPS syndromes include chronic fatigue syndrome, fibromyalgia syndrome, and multiple chemical sensitivities."  Another review, "Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS)"  has five main MUPS syndromes like CFS and fibromyalgia. They all say CFS and FM, some say IBS or MCS. RetroS1mone talk 12:51, 17 July 2009 (UTC)
replies: text: I agree, those are examples of MUS syndromes, no question there.  I just think we need to be careful not to bias the article further in favour of certain conditions when there are so many that are encompassed by the term.  For now, I've re-worded it to be closer to the cited source, which did not say that MUPS commonly referred to those illnesses, just that those were examples of syndromes consisting of MUPS (as you stated in your quotation of it). --RobinHood70 (talk) 00:50, 18 July 2009 (UTC)
replies: text: Rob and Ward20 i do not want to be disrespectful but pls read the abstract, it says "Medical science, with its emphasis on identifying etiologically meaningful diseases comprised of homogeneous groups of patients, has split MUPS into a number of diagnostic entities or syndromes, each with its own hypothesized pathogenesis. However, research suggests these syndromes may be more similar than different, sharing extensive phenomenological overlap and similar risk factors, treatments, associated morbidities, and prognoses. Examples of syndromes consisting of MUPS include chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, somatoform disorders, and 'Gulf War Syndrome.'" I put the bold in, it says overlap. RetroS1mone talk 03:54, 18 July 2009 (UTC)
replies: text: Yes, I did read that, and "phenomenological overlap" is much like saying that a cold, flu, and allergies have overlapping phenomena...that doesn't mean the conditions themselves overlap.  You might want to get a second opinion on your interpretation of that phrasing from WikiProject Medicine or somewhere similar, though.  Also, I like what you've done with the "one use of the term" phrasing.  I think that helps clarify that there are a number of different usages. --RobinHood70 (talk) 08:41, 18 July 2009 (UTC)
thread_title:  Dead Link 

message: There are only two articles and no reviews mentioning Unexplained physical symptoms (UPS) using a medline search for ("Unexplained physical symptoms" UPS). I am removing the term from the lead per WP:WEIGHT. The UPS link redirects back to Medically unexplained physical symptoms anyway. Ward20 (talk) 23:21, 19 July 2009 (UTC)
thread_title:  Unexplained physical symptoms (UPS) 

message: Some editors say this article is a POV fork, pls help put in balance and weight from MEDRS. I made edit about patient perspective on the names and the BMJ review 2008 advise to doctors about not blaming patient, i am hoping, we can make it a better article. RetroS1mone talk 03:44, 22 July 2009 (UTC)
replies: text: "Symptoms are generally not thought to be psychiatric in origin" + "MUPS may be synonymous with somatization disorder[6] or psychosomatic illness, where the cause or perception of symptoms is mental in origin." Sam Weller (talk) 21:59, 22 July 2009 (UTC)
replies: text: That just goes to show the variety of views of MUPS that are out there.  Perhaps we should re-word the article to present the fact that MUPS means very different things to different people. --RobinHood70 (talk) 22:25, 22 July 2009 (UTC)
replies: text: Authors of articles seem to have an agenda to describe MUPS as they would like it to be and there isn't much agreement. To make matters more complicated in the Fibromyalgia article RetroS1mone piped medically unexplained syndrome to MUPS. I searched the terms "medically unexplained syndrome" and medically unexplained symptoms and came up with 6 studies. Two talked about FM but didn't seem to establish any intent to link the phrases in an intentional manner.   Ward20 (talk) 01:18, 23 July 2009 (UTC)
replies: text: A syndrome is a constellation of symptoms. A condition with medically unexplained symptoms is a medically unexplained syndrome. It is not OR it is definitions. RetroS1mone talk 03:01, 23 July 2009 (UTC)
replies: text: That definition makes approx. 66% of women that walk into a gynecology clinic with medically unexplained symptoms have a "medically unexplained syndrome". That is an exceptional claim. Sorry, editor's definitions are OR until links are provided, "A condition with medically unexplained symptoms is a medically unexplained syndrome." Please supply WP:RS for that. Ward20 (talk) 06:10, 23 July 2009 (UTC)
thread_title: Balance

message: I took out original research said Slavney first used MUS in 1985, that is wrong, 1972 paper "The patient must report at least 25 medically unexplained symptoms for a "definite" diagnosis"  and there is alot more from 1970 to 1985 like 7412070 and 7241113. RetroS1mone talk 01:14, 24 July 2009 (UTC)
replies: text: I'm sure the phrase "medically unexplained symptoms" goes back a lot farther than the '70s...it's an easy enough series of words to put together in a medical setting.  But we can't build an article about a random phrase, so the question becomes:  When was it used to indicate a specific category of illnesses?  I have no idea if Slavney was the first to do so or not, but I think that we're confounding the phrase with an actual category.  A common phrase is probably not notable by Wikipedia standards; a medical category might be if it's in wide use.  So I think we need to identify when this phrase was first coined to refer to a category of illnesses and prove that it's actually noteworthy.  Without an entry in DSM-IV or a similar medical reference, the notability of the concept really needs to be shown.  Also, as someone else said somewhere, if it is considered a medical category somewhere, we need to identify if it's primarily a psychiatric/psychological concept or a broader one.  Similarly, I think we're also confounding the category with related terms like "somatoform disorder" and "functional somatic symptoms".  Unless the source itself says that in that particular text they're intended to mean the same thing, any assumption that another text is making the same assumption would be synthesis. --RobinHood70 (talk) 01:43, 24 July 2009 (UTC)
replies: text: Agreed about synthesis, Rob. Not only is MUPS missing from ICD and DSM, it's not a MESH term either, which should raise concerns. A quick Medline MUPS search shows that it is not a common term, and is used predominantly by psychiatrists and psychologists, whether writing in their own trade journals or in general medicine. And the article itself makes it very clear that psychiatrists have adopted MUPS/MUS as part of their FSS and somatization constellation. Sam Weller (talk) 08:54, 24 July 2009 (UTC)
thread_title:  First use 

message: I must object to the categorization of RetroS1mone's recent changes as "accurate".  In the RESULTS section of Nimnuan (et al) study, it specifically states:
:"Psychiatric morbidity per se was not associated with the presence of medically unexplained symptoms, but was more likely in those complaining of multiple symptoms."
In the Kirmayer work, it states:
:"Physicians often assume that psychological factors account for these symptoms, but current theories of psychogenic causation, somatization, and somatic amplification cannot fully account for common unexplained symptoms."
How is:
:"Symptoms may not be due exclusively to psychiatric factors but psychiatric co-morbidity is common."
...an accurate representation of those two statements? --RobinHood70 (talk) 04:03, 25 July 2009 (UTC)
replies: text: The sources say, there is more then psych factors only, they are a big part but they do not say all symptoms are from them. You wrote, "Symptoms are generally not thought to be psychiatric in origin" that is not right. RetroS1mone talk 04:11, 25 July 2009 (UTC)
replies: text: I agree that the sources say there are more than psychiatric factors only, but the first one says "not associated" (the source of my "generally not thought to be psychiatric") and the second one says "cannot fully account for".  Clearly, they both indicate that some cases are psychiatric in nature (which is reflected in the "generally" and in the "multiple symptoms" section), but they also both clearly indicate that not all are psychiatric in nature.  Writing "...may not be exclusively due to..." implies that the symptoms are due to both psychiatric and other causes simultaneously.  And leaving off the info about it being more common among "those complaining of multiple symptoms" really changes the entire meaning of what the sources are saying. --RobinHood70 (talk) 04:23, 25 July 2009 (UTC)
replies: text: Nimnuan finds a little different results from other sources about MUS for the psychiatric comorbidity and they talk about it in thier discussion, why they think it is, they do not say they think symptoms do not have any psychiatric origin like you wrote. "implies that the symptoms are due to both psychiatric and other causes simultaneously." that is right, example  it is very hard for seperating "psychiatric" and "organic" in MUS. They are very complicated illnesses and there is not black and white but literature says high psychiatric comorbidity. RetroS1mone talk 12:48, 25 July 2009 (UTC)

text: Kroenke review 12830308 "Unexplained or multiple somatic symptoms are strongly associated with coexisting depressive and anxiety disorders. Other predictors of psychiatric co-morbidity include recent stress, lower self-rated health and higher somatic symptom severity, as well as high healthcare utilization, difficult patient encounters as perceived by the physician, and chronic medical disorders. Antidepressants and cognitive-behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache." RetroS1mone talk 12:52, 25 July 2009 (UTC)
replies: text: I'm not saying there's no co-morbidity, there quite obviously are in many cases, just that the sources cited don't indicate a strong link in the general case. --RobinHood70 (talk) 20:01, 25 July 2009 (UTC)
replies: text: I added 2 more references on co morbidity, the Chinese large scale study BC it is not just Western result, the meta-analysis of IBS, NUD, CFS, and FM MUS BC it has balance, says it is not only mental disorder. RetroS1mone talk 03:20, 28 July 2009 (UTC)
thread_title:  Intro - psychiatric morbidity 

message: This text was introduced  by IP:212.130.131.1 citing "A novel and effective treatment modality for medically unexplained symptoms." (Steele et al 2009) : "The most effective current treatment for some medically unexplained symptoms is a combination of therapeutic approaches tailored to the individual patient. Most MUS patients are in need of psychotherapy, relaxation therapy and physiotherapy under medical supervision. A Combined therapeutic approach which is at least twice as effective as other therapeutic modalities published to date ...". I was able to verify that the article exists , but can someone please verify the content and WP:WEIGHT?  - Tekaphor (TALK) 02:26, 22 February 2010 (UTC)
replies: text: I found the abstract  but couldn't get farther and couldn't find the article indexed on medline. I think it wise to get the actual wording to verify, "The most effective current treatment". This article may be an opinion piece based on clinical experience would not be a strong reference for the material per WP:MEDASSESS. Ward20 (talk) 06:04, 22 February 2010 (UTC)
replies: text: While the Steele research is interesting, I'm not sure if we should be including it here (and saying it is 'the most effective') as it has zero citations, isn't in medline and is just a primary study. A quick search on google scholar seems to show that CBT is the current most effective treatment. --sciencewatcher (talk) 19:21, 27 May 2011 (UTC)
thread_title: "The most effective current treatment"

message: In the opening paragraph, it states " The term does not necessarily imply that a physical cause does not exist, but rather notes that cause(s) for given symptoms are uncertain, unknown or disputed—there is no scientific consensus. "
The History and Usage section below it, however, contradicts this:
"MUPS may be synonymous with somatization disorder[14] or psychosomatic illness, where the cause or perception of symptoms is mental in origin, or may overlap these terms or be a "lower threshold variant" of them.[15] Because several definitions of both somatization and MUPS exist, and the usage of both terms is inconsistent in medical literature and practice, MUPS is sometimes used interchangeably with somatization and functional somatic symptoms,[16] although "somatised mental distress" and "somatisation disorders" (based on symptom counts) may not adequately account for most patients seen with MUPS.[12]
One suggestion to reconcile:
In the opening paragraph, "Strictly speaking, the term itself does not imply that a physical cause does not exist, but rather that cause(s) for given symptoms are uncertain, unknown or disputed. However, in practice, the use of the term usually implies that the cause of the symptoms is believed to be psychological".
Feedback, please?
Wilshica (talk) 04:57, 7 July 2015 (UTC)
thread_title:  Some contradictions within this page - suggestions for improvement? 

message: Hi Ozzie10aaaa,I like what you've done withe the MUPS wikipedia page, good refs and image. But I hope you won't be offended that I have suggested reverting some of the previous material you deleted. Its important to make clear why a doctor-patient conflict arises in the first place - its to do with the doctor's belief that the symptoms have a psychological cause, and the patient's belief that they are physical in origin I've tried to keep in your new material though, about questioning the doctor's competence. I didn't know what to do with your comment about MUPS leading to a "vegatative state", that's not a widely held belief amongst physician or researchers. Do you mean high morbidity, perhaps?Wilshica (talk) 11:27, 19 July 2015 (UTC)
replies: text: Wilshica there is no problem, that is what we are all here for... the link and wording was actually vegetative symptoms,and the link is Wikipedia:Identifying_reliable_sources_(medicine).Thank you for your question (BTW don't you think it might be best to shorten the lead a bit ...should be more compact per Wikipedia:Manual_of_Style/Medicine-related_articles#Sections)--Ozzie10aaaa (talk) 11:40, 19 July 2015 (UTC)

text: agree with you, good (description section sounds OK)...that second reference you have is very good--Ozzie10aaaa (talk) 00:22, 20 July 2015 (UTC)

text: I've rewrote the text to fix these problems. --sciencewatcher (talk) 20:01, 4 December 2017 (UTC)
thread_title:  response/MUPS 

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thread_title:  External links modified 

message: Hi @BlenFans, I’m bringing this up here because my edit was reversed, I wanted to say this page’s characterisation of ME/CFS as a MUPS is outdated. The current medical literature ME/CFS is considered as a biological condition without clearly defined aetiology but with consistent findings of abnormalities. You can see the Wikipedia article for ME/CFS itself which has been greatly improved recently, is classified as a good article, and is well on its way to becoming a featured article. (This comment is similar to the one I posted on the FSS page as it is for similar reasons).
Here are some sources anyways:
“Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, multi-system disease […] studies show neurologic, immunologic, autonomic, and energy metabolism impairments.” Mayo clinic proceedings https://www.mayoclinicproceedings.org/article/S0025-6196(21)00513-9/fulltext#secsectitle0035
‘numerous studies over time have uncovered organic abnormalities in patients with ME/CFS, and the majority of researchers to date classify the disease as organic’ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10819994/
There is much more evidence on the ME/CFS wikipedia page. Due to this evidence I think ME/CFS should be removed from the MUPS wikipedia page, or at the very least there should be an acknowledgment that its status as MUPS is controversial.  
Additionally the citation which is used to justify the classification of ME/CFS as MUPS is from 2004, research into ME/CFS has highly advanced since then, and especially since 2017. 
Thanks :) (from someone who spends way too much time reading me/cfs research.) YannLK (talk) 18:45, 14 April 2024 (UTC)
thread_title:  The place of ME/CFS in this article