Medically unexplained physical symptoms (MUPS) are those without relevant organic pathology and are commonplace in primary care and specialty medical care settings. MUPS disorders include fibromyalgia (FM), irritable bowel syndrome (IBS), multiple chemical sensitivity, chronic fatigue syndrome, and others. The etiologies of FM and IBS are poorly understood and are likely multifactorial and complex. Common factors include symptom hypersensitivity or amplification, hypothalamic-pituitary-adrenal axis perturbation, and genetic vulnerability. A sexual abuse history may play a role as well. Significant comorbidity exists between IBS and FM. Patients with both disorders have more physical and psychiatric symptoms than those with only one disorder. FM and IBS can generally be diagnosed with a careful history and physical exam plus judicious use of laboratory studies. Treatment is symptomatic and includes addressing psychiatric issues with medications, non-medication therapies, and supportive, caring attitudes.
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