Studies have found that patients' symptoms in many cases persist beyond the point at which pathophysiological observations can adequately explain them.
Symptoms not adequately explained by traditional medical research paradigms are common across medicine and represent the most common diagnosis in some specialities.
Persistent symptoms are highly prevalent in the general population
and even within well-defined disease cohorts there is often little association between objective pathophysiology and symptom burden.
FigureCausal model of interaction of biological, social, experiential, and psychological factors in long COVID
Specific linear causal processes within the organs and tissues are not able to explain all physical suffering. For some conditions, it is necessary to approach treatment holistically rather than on an individual pathophysiological basis. Effective treatments and rehabilitation approaches for functional disorders are known,
and many of them are already employed in long COVID clinics. However, explicit explanatory models that address the need for a multidisciplinary and integrated treatment provision are key to better clinical services. Poorly integrated explanatory models contribute to poor care and stigma for people who are ill in these specific ways.
In summary, we highly welcome research into the cellular and physiological mechanisms behind persistent symptoms, including post-viral fatigue. However, it is increasingly clear that simple, causative relationships between pathophysiology and symptoms inadequately explain many diseases and chronic health conditions, including long COVID. There is an available body of literature on the multiple factors involved in the generation, perception, and persistence of functional symptoms, and models through which to integrate these. We are moving into a new era in long COVID research and treatment that would benefit from an integrated paradigm through which to understand human illness. We suggest it is time to break taboos based on a dualistic understanding of physical versus mental illness and bring in existing knowledge about functional somatic symptoms to provide improved explanations and treatments.
We declare no competing interests.
References
- 1.
Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study.
Lancet. 2022; 400: 452-461
- 2.
The immunology and immunopathology of COVID-19.
Science. 2022; 375: 1122-1127
- 3.
A longitudinal study of COVID-19 sequelae and immunity: baseline findings.
Ann Intern Med. 2022; 175: 969-979
- 4.
Medically unexplained symptoms: an epidemiological study in seven specialities.
J Psychosom Res. 2001; 51: 361-367
- 5.
Prevalence of functional somatic syndromes and bodily distress syndrome in the Danish population: the DanFunD study.
Scand J Public Health. 2020; 48: 567-576
- 6.
Association between pulmonary function and asthma symptoms.
J Allergy Clin Immunol Pract. 2019; 7: 2319-2325
- 7.
Management of somatic symptom disorder.
Dialogues Clin Neurosci. 2018; 20: 23-31
- 8.
Physiotherapy for functional motor disorders: a consensus recommendation.
J Neurol Neurosurg Psychiatry. 2015; 86: 1113-1119
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Published: January 05, 2023
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