Terminology Should be Better Explained
In 2013, the first version of the S3 Guideline “Treatment of non-specific, functional and somatoform bodily complaints” (1) appeared.
The updated version (2) first describes the term “functional somatic symptoms” in three areas. However, the authors fail to explain the terms “function” / “functional” used in various ways. The first version of the guideline states approximately (on page 21/22): “The term functionally indicates that it is primarily the function, not the structure, of the organ system (affected by the symptoms)… that is disturbed.”
In our view, this definition needs to be supplemented. In case of disorders of the musculoskeletal system, the concept of function is also used. In addition to the psyche and the soma, the third pole is the function chain (for symptoms in the quadriceps muscle, the iliopsoas and spinal erectors muscles in the back should also be examined). This leads to the realization that the source of a symptom can be in a complete distinct area of the body than where the symptom is localized. Clinical medicine has a very hard time with this. A recommendation for manual therapy would have been appropriate for this (3).
Overlooking tense skeletal muscle for the classification of symptoms cannot be compensated by the term “psychic” or simply as “functional”.
The actual meaning of the guideline is that symptoms that are somatically presented but that cannot be treated by somatic measures should be considered from the outset from a psychological point of view.
Also important are the approaches presented here for unclear symptoms (see especially Box 2 and Key Messages in ).
Dr. med. Michael Brinkers
Schmerzambulanz der Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikl Magdeburg A.ö.R., Germany
Conflict of interest statement
Dr. Brinkersis a member of the working group “Function Disorders” of the Medical Association of Manual Medicine (Ärztevereinigung für Manuelle Medizin e. V.).
|1.||Hausteiner-Wiehle C, et al.: Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden. S3-Leitlinie. Stuttgart: Schattauer 2013.|
|2.||Roenneberg C, Sattel H, Schaefert R, Henningsen P, Hausteiner-Wiehle C: Clinical practice guideline: Functional somatic symptoms. Dtsch Arztebl Int 2019; 116: 553–60 VOLLTEXT|
|3.||Henningsen P, et al.: Management of functional somatic syndromes and bodily distress. Psychother Psychosom 2018; 87: 12–31 CrossRef MEDLINE|