Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach to promote recovery

Abstract

Background: A substantial proportion of people consulting primary care practitioners have symptoms that persist even after structural problems and diseases have been excluded. They experience distressing somatic complaints–such as fatigue, pain, headaches, and brain fog–lasting months or longer which impair quality of life and workability. In this article, we refer to these as persistent physical symptoms (PPS). When diagnosis, advice and care are based solely on a biomedical interpretation of symptoms, patients may not improve. This can result in repeated and often frustrating consultations and investigations. Aim: To outline contemporary theories around PPS for general practitioners, and offer practical, evidence-informed pathways to use in primary care. Methods: Narrative literature review and consensus development with experienced practitioners. Synopsis:Contemporary theories Contemporary theories of PPS provide a coherent framework for understanding symptom persistence and guide treatment. These theories propose that symptoms may arise from brain-based responses to perceived threat, influenced by expectations and learned associations. Such responses can become unhelpful when benign sensations are interpreted as dangerous. Biopsychosocial factors unique to each individual influence these mechanisms which need to be considered when assessing PPS and working towards symptom resolution with the patient. Evidence-informed pathways Key strategies include validating patients’ symptoms and emotional experiences, providing clear explanations of symptom persistence, and developing personalised management plans that combine biological, psychological, and social approaches. Such strategies can reduce or resolve symptoms, foster hope and a sense of agency, and often lead to recovery.