Tuesday 15 November 2011

What are Functional Symptoms?

Doctors who recognise that “Medically Unexplained Physical Symptoms” is an unhelpful description often favour the term “functional” symptoms, which from a lay man’s point of view isn’t much better at indicating the presence of persistent, genuine suffering.

What do doctors mean by Functional Symptoms?

Professor David Peters from the New Medicine Group says that “what's been discovered in cases of chronic conditions or “long term low-wellbeing”, is that the body isn’t functioning as it ought to. For example, when people have a persistent pain syndrome, even though the brain isn't damaged, it reacts differently. In IBS the gut responds differently to stress; in CFS the muscles react differently to exertion. In all cases the organs are intact and undamaged, but they are aren’t functioning normally.” This change in the way the body is functioning explains the experience of ill health.

In the case of Functional Symptoms in Neurology:

According to Dr Jon Stone, Consultant Neurologist (Edinbrough), of neurosymptoms.org “functional implies in the broadest possible sense a problem (of the nervous system) due to a change in function of the nervous system”. He says that Functional Symptoms account for around 1/3 of all patients seen in hospital medical clinics.

According to Dr Stone: “Patients with functional symptoms are, on the criteria of distress, disability, and persistence of symptoms, as deserving as patients with a pathologically defined disease.” Dr Stone seems to be aware that these patients are not always treated with the same compassion or care.

I say this, because he opens his paper “Functional Symptoms in Neurology” with a direct warning to fellow neurologists — a warning that no patient or layman would ever get away with! He says “If you find people with ‘neurological symptoms but no disease’ tiresome and not really what you came in to the speciality for, then you are going to find larger parts of your job tiresome - and worse - you attitude will filter through in a negative way to the patients regardless of the form of words you use to talk to them.” At last! A neurologist who understands! He has even built a website to explain to patients, their friends, and family, how neurological symptoms without disease can be understood. Be sure to check out the section “All in the mind?” (The answer is no, it’s not). Go to: www.neurosymptoms.org

Well-known Functional Symptoms

Since functional symptoms often come in patterns - called syndromes - they are widely recognised and have been given names. “So people with unexplained bloating, irregular bowel habit and abdominal pain are told they have Irritable Bowel Syndrome (IBS); people with aching muscles in many parts of the body are said to be suffering from Fibromyalgia Syndrome (FMS); people with prolonged exhaustion are diagnosed as having Chronic Fatigue Syndrome (CFS)”. (Source: NMG)

All these syndromes have much in common with Migraines: the experience of a migraine can debilitating, but tests and scans will not show up any evidence of the pain and discomfort the patient is suffering. A diagnosis is reached through talking to the patient, and being able to acknowledge to the patient: “Yes, I recognise these symptoms.”

Despite these similarities; despite the absence of any known cause for migraine, you will be aware that migraine is more widely accepted as a ‘real’ health complaint. I propose that migraine is easier for people to understand because you can reasonably accept the migraine sufferer to say, at some point, “I feel better now.” In this way, a migraine is less disturbing, and fits our ideas of what ill-health looks like: a migraine has a clear beginning, middle, and end.

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