By Suleiman Tajudeen
CITIZENS COMPASS— Medically Unexplained Symptoms (MUS) are physical symptoms such as pain, fatigue, dizziness, or gastrointestinal complaints that persist for weeks to months despite appropriate medical assessment, but for which no clear organic disease can be found on examination or investigation.
The symptoms are real to the patient and could cause distress or functional impairment, though tests like blood work, scans, and X-rays are normal. In DSM-5, severe forms fall under Somatic Symptom Disorder. In Nigeria, patients often present these symptoms in PHC and general OPD clinics.
Major characteristics:
Real and distressing to the patient: The pain, fatigue, or dizziness is genuinely experienced. It is not faking. Patients often feel dismissed when they are told that nothing is wrong.
Negative investigations: Blood tests, X-rays, scans, and physical exams fail to reveal an organic cause that matches the severity of symptoms.
Chronic or recurrent pattern: Symptoms last more than three months or keep returning. Examples include chronic headache, IBS-like pain, and non-cardiac chest pain.
Disproportionate to findings: A patient may report being unable to walk, but the neurological exam is normal.
Multiple systems involved: One patient may have fatigue, abdominal pain, dizziness, and palpitations at the same time.
Linked to functional impairment: Patients miss work, school, or social activities because of symptoms.
Common in primary care: In Nigeria, 20 to 40 percent of PHC and OPD patients fall into this category.
Overlaps with somatic symptom disorder: DSM-5 classifies severe cases where thoughts and behavior around symptoms cause distress.
Influenced by culture: In Nigeria, distress is often expressed as body pain or weakness rather than sadness due to stigma.
Not a diagnosis of exclusion only: Modern practice gives a positive diagnosis like functional abdominal pain rather than just saying we found nothing.
In Nigeria, patients with MUS often present in PHC, general outpatient clinics, and traditional healers before reaching the hospital.
Major causes
MUS arises from the interaction of biological, psychological, social, and healthcare factors.
Central sensitisation: The nervous system becomes overly sensitive to pain signals. Normal signals feel painful. Seen in fibromyalgia and chronic back pain.
Autonomic nervous system dysregulation: Stress disrupts heart rate, gut motility, and breathing, causing palpitations, IBS, and dizziness.
Chronic stress and anxiety: Prolonged cortisol release alters sleep, immunity, and pain thresholds. Common among Nigerian students and workers.
Depression: Low mood often presents as fatigue, body aches, and poor appetite in African populations.
Trauma and adverse childhood experiences: Abuse, war, or domestic violence increase the risk of MUS in adulthood through altered stress response.
Health anxiety and catastrophic thinking: Misinterpreting normal bodily sensations as cancer or a heart attack worsens symptoms.
Cultural expression of distress: In many Nigerian communities, emotional problems are expressed as physical symptoms to avoid stigma.
Sleep disturbance: Poor sleep lowers pain threshold and worsens fatigue, creating a vicious cycle.
Iatrogenic factors: Repeated tests, conflicting opinions, and medical jargon increase anxiety and symptom focus.
Secondary gain: Time off work, attention from family, or financial benefits can unconsciously reinforce symptoms.
Effects
MUS affects the….
To be continued….
For questions and medical consultations, contact: Dr. Suleiman Tajudeen, CEO and Director of Clinical Psychology, Clear Mind Psychological Consult, Km 15, Badagry Expressway, Ojo, Lagos. +234 803 402 4457
