Unexplained physical symptoms: What can help?

When people have physical symptoms, they usually want to understand why. It is disappointing to realize that the doctor has no clear explanation. Sometimes, people might feel like their symptoms aren't being taken seriously. So it’s important to find a doctor who does take you seriously and wants to help you.

When looking for possible explanations together, it may help to ask the following questions:

• Does anything trigger the symptoms? Does anything make them worse or better?
• Do you feel stressed and overwhelmed – for example, by a situation at work, because you’re caring for a family member, or because you have to juggle work, family and household chores?
• Could certain circumstances in your life play a role – for example, are you in a conflict-filled relationship or has a close relative died?
• Might your lifestyle or work be a factor – for example, having an unbalanced diet or doing mostly sedentary work without enough physical exercise to balance it out?
• Might any current or past medical conditions play a role?

Various physical, mental and social factors generally increase the likelihood of developing unexplained physical symptoms. Because of this, the aim of treatment is to figure out which factors could be playing a role, and then make changes to reduce those factors. One-sided explanations are usually wrong and also not very helpful.

It is often a good idea to wait and see what happens at first. Unexplained physical symptoms often get better by themselves after some time, and then no treatment is needed. If there’s no serious underlying condition, that usually soon becomes clear at the doctor’s.

Taking the "wait and see" approach doesn’t mean not doing anything about it. On the contrary: It is important to be active. Your doctor can give you tips on how to manage the symptoms and also offer you advice – for example, on how to better manage stress and what types of exercise are suitable.

If you try to manage the problems that way first, it’s best to schedule another doctor's appointment after a few weeks or months. At that appointment, you can take a look at how the symptoms may have changed. If they’re still a problem, you can then talk about the treatment options or other forms of support. You can see your doctor sooner if the symptoms get a lot worse before that appointment.

If the symptoms have been very distressing for a long time, it may not be a good idea to "wait and see" for even longer. Instead, you could ask a doctor or psychotherapist for advice on other types of help.

In rare cases, it helps to rest for a while – for example, if the symptoms are especially bad. But too much rest is not a good thing in the long term. In fact, rest can make the symptoms even worse.

An example: Take a man who often feels dizzy. Because he’s worried about getting dizzy, he spends a lot of time in bed. This weakens his body overall, increasing the likelihood that he will feel dizzy. Plus, not doing anything makes you focus even more on your symptoms and generally further reduces your drive to do anything. Physical rest can also lead to muscle loss and joint stiffness.

Taking a lot of sick leave can cause problems at work, or you may even lose your job. If you become very withdrawn, it can put a strain on your friendships and family life too.

Staying active or becoming active yourself often takes strength. You’re more likely to be successful if you find activities that are fun and may even open new perspectives. This can also distract you, make you feel good, and give you a sense of achievement.

Your options will depend on your personal interests and the type of symptoms you have. For example:

• Sports such as ball sports, strengthening and stretching exercises, jogging or cycling
• Physical exercises taken from activities like yoga, tai chi or pilates
• Relaxation techniques like progressive muscle relaxation or autogenic training
• Mindfulness training, stress management, meditation
• Changing your diet, for example to a high-fiber diet if you have bowel problems
• Dancing, drawing, making music, pursuing hobbies
• Meeting up with friends
• Involvement in the community
• Changing your job
• Joining a support group
• Learning about how to manage the symptoms (books, websites). But be careful: There's a lot of poor-quality health information out there too.

Some changes can be easily integrated into everyday life – like taking the stairs instead of the elevator, cycling to work, or going on more walks. Getting more exercise can make you feel more positive about your body.

Studies have shown that special support programs (for example, online or using books) can be effective too. These programs teach you self-help strategies to help you better manage the problems. You can ask your doctor about suitable support programs for you.

It is also important to face problems and conflicts rather than avoiding them, and rethink how you deal with them. If that doesn’t help, you could consider making major changes – like changing your job if you are constantly stressed at work.

If the symptoms start affecting your mental health or you have a very hard time coping with them in everyday life, psychological support can help. The best-studied psychological approaches are treatments based on cognitive behavioral therapy (CBT). But psychoanalytical approaches are sometimes used, too.

At first, psychological treatment involves trying to find possible explanations for the symptoms, as well as factors that make them worse. The aim is to understand the relationship between your mind and physical symptoms – for example, how your perceptions and emotions affect the way you experience symptoms. Distressing life circumstances and past experiences can play a role here.

But the main aim of psychological treatment is to find solutions, especially to help you better cope with the symptoms. For example, you can learn relaxation techniques or distraction techniques that also help you to deal with physical symptoms. A further aim of psychological treatment may be to reduce concerns about physical activity being harmful, and then help you to become more active again.

You can ask about specific treatment offers in family doctors', psychotherapists' or psychosomatic specialists' practices. In Germany, psychotherapy practices also offer initial consultation sessions where they assess your situation and need for treatment.

In some situations, other treatments without medication may be considered. These include physical therapy (physiotherapy), treatments based on physical stimuli (like applying heat) and occupational therapy. If the problem is very persistent, though, it generally only makes sense to use these approaches in addition to other measures and increasing your own level of activity.

These non-medication treatments can't always be prescribed, so you sometimes have to pay for them yourself. There is little research on their effectiveness in the treatment of functional symptoms.

Purely passive treatments (like massages or applying heat) can make you feel better for a short while, but are very unlikely to relieve the symptoms in the long run. Approaches that involve becoming active yourself are probably more likely to help.

In Germany, some doctors may offer you individual health care services that fall under the category of "IGeL services." It is advisable to critically question whether you really need these treatments. Statutory health insurers don't cover the costs because there's usually no scientific proof that they help. This means that there's also no harm in turning down the offers.

Medications have a limited effect here, if any. Sometimes, they temporarily reduce some symptoms, but they don’t get rid of the possible triggers. Also, people who rely too much on medications often neglect other approaches, like sports and stress management. Medications can have side effects, too.

There is hardly any research on the effectiveness of commonly used medications in the treatment of functional symptoms. These medications include:

• Painkillers: Non-steroidal anti-inflammatory drugs (NSAIDs) are usually the only real option in this group. Opioids should generally be avoided.
• Medication for mental health problems: If you have chronic pain or depression, antidepressants are sometimes considered. Benzodiazepine-based sedatives and sleeping pills are not recommended because you can become dependent on them. Antipsychotics are typically not recommended either.
• Anti-seizure medication (anti-epileptic drugs): This medication is usually taken for epileptic seizures, but it is occasionally prescribed for nerve pain (neuropathic pain) too.

Medications for bowel problems or sleep problems may also be an option.

It is always important to weigh the potential benefits of a medication against its potential side effects. When it comes to the treatment of unexplained physical symptoms, medication should only be used very sparingly.

It is normal to feel disappointed if your doctor can’t offer you a treatment that will provide fast relief. But there is often no direct solution. And it's not a good idea to keep trying out new medical treatments. Instead, it's better to try other approaches – like getting more exercise and improving your stress management skills.

It helps to set realistic treatment goals. For example, a first goal could be to start cycling regularly despite the symptoms. It is not realistic to expect the symptoms to disappear when you do that, but the goal of using your bike more often is specific and realistic. Having some success can then motivate you to set more goals. And if at some point your symptoms really do improve or even go away completely, all the better!