New Therapy May Help Patients with Unexplained Pain and Fatigue

A new type of therapy may help patients with symptoms such as pain, weakness, or dizziness that can’t be explained by an underlying disease, according to a study published in the July issue of Neurology. These symptoms, which can also include fatigue, tingling and numbness, are also known as functional or psychogenic symptoms.

“People with these symptoms make up one-third of all clinic visits, but the outcomes are poor,” said study author Michael Sharpe, MD, of the University of Edinburgh, in a statement.

Previous studies have shown that intense cognitive behavioral therapy can reduce symptoms, distress, and disability in people with these symptoms, but there are obstacles to providing this therapy. Many individuals do not feel psychological treatment is appropriate and resist referrals to mental health services, and therapists trained in cognitive behavioral therapy are not available in all communities.

Cognitive behavioral therapy aims to improve people’s physical symptoms, emotional state and functioning by helping them to understand, and where necessary change, how they think about and respond to their symptoms and life situation.

For the study, the researchers developed a self-help workbook based on the therapy for patients with physical symptoms. A total of 62 people were given the workbook; over a period of 3 months, they underwent up to 4 half-hour sessions guiding them in the use of the book with a nurse at their neurologist’s office in addition to their usual medical care. They were compared to 63 people who received only their usual medical care. Most of the participants also had psychiatric diagnoses, such as panic disorder, anxiety disorder and depression.

After 3 months, individuals who received the extra therapy were approximately twice as likely to report improvements in their overall health as those who did not receive the extra therapy. A total of 13% more people who received the extra therapy reported that their health was “better” or “much better” than those who received only their usual care.

After 6 months, there was no longer a significant difference in improvements in overall health between the two groups. However, those receiving the extra therapy continued to have greater improvement in their symptoms than those who received the usual care and also in their physical functioning. They were also more satisfied with their treatment.

“This study suggests that cognitive behavioral therapy-based guided self-help may be a new and potentially useful first step in improving the management of these challenging symptoms,” Dr. Sharpe said. “This approach needs further evaluation but can be a potentially effective and cost-effective first step toward providing more help for these often neglected patients.”