• Bernd Löwe, Anne Toussaint, RosmalenJudith G MJGMDepartment of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands., Wei-Lieh Huang, Christopher Burton, Angelika Weigel, James L Levenson, and Peter Henningsen.
• Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. Electronic address: b.loewe@uke.de.
• Lancet. 2024 Jun 15; 403 (10444): 264926622649-2662.

AbstractPersistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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