477 CBT effective for medically unexplained physical symptoms

February 02, 2016

written by Brian R McAvoy

Clinical question
How effective are non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults?

Bottom line
Cognitive behavioural therapy (CBT) was more effective than usual care or waiting lists in reducing the severity of MUPS, but effect sizes were small. The effects were durable within and after 1 year of follow-up. CBT was no more effective than enhanced care provided by the person’s doctor. The intervention groups reported no major harms. The overall quality of evidence was low to moderate.

Caveat
As a single treatment, only CBT has been adequately studied to allow tentative conclusions for practice to be drawn. There were no studies that included physical therapy. In practice, a substantial proportion of people with MUPS may not be willing to accept psychologically-oriented treatments.

Context
MUPS are physical symptoms for which no adequate medical explanation can be found after proper examination. The presence of MUPS is the key feature of conditions known as somatoform disorders. Various psychological and physical therapies have been developed to treat somatoform disorders and MUPS, but a complete overview of the whole spectrum is missing.

Cochrane Systematic Review
Van Dessel V et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Reviews, 2014, Issue 11. Art. No.: CD011142.DOI: 10.1002/14651858. CD011142.pub2. This review contains 21 studies involving 2658 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.