Medically Unexplained Symptoms - Robert W. Baloh

Medically Unexplained Symptoms

A Brain-Centered Approach

Despite the rapid advances in medical science, the majority of people who visit a doctor have medically unexplained symptoms (MUS), symptoms that remain a mystery despite extensive diagnostic studies. The most common MUS are back pain, abdominal pain, headache, fatigue, and dizziness. Les mer
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Despite the rapid advances in medical science, the majority of people who visit a doctor have medically unexplained symptoms (MUS), symptoms that remain a mystery despite extensive diagnostic studies. The most common MUS are back pain, abdominal pain, headache, fatigue, and dizziness. This book addresses the obstacles of managing people with MUS in our modern day society from both a historical and contemporary perspective.

Most MUS are psychosomatic in origin, caused by a complex interaction between nature and nurture, between biological and psychosocial factors. Psychosomatic symptoms are as real and as severe as the symptoms associated with structural damage to the brain. Unique and concise, the book explores the biological and psychosocial mechanisms, the clinical features, and current and future treatments of common MUS.

Exploring the unsolved in an accessible manner, Medically Unexplained Symptoms invokes the methodologies of medical science, history, and sociology to investigate how brain flaws can lead to debilitating symptoms.
Forlag: Springer Nature Switzerland AG
Innbinding: Paperback
Språk: Engelsk
Sider: 204
ISBN: 9783030591809
Format: 24 x 16 cm

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Chapter 1. Overview of Medically Unexplained Symptoms


Brain flaws






Diagnostic uncertainty

Chapter 2. Early ideas on hysteria

Hysteria and female sexuality

Bizarre behaviors

Hysteria and the occult


Hysteria, a nervous disorder

Early treatments of hysteria

Spinal irritation and the spinal reflex theory

The attack on the female genitalia

Hysteria and fasting girls

Chapter 3. The Golden age of Hysteria

Briquet's syndrome

Charcot and his hysterical circus

Hysteria and hypnosis

Borderlands of hypnosis

Nature or nurture

Ideas about hysteria evolve

Neurasthenia and neurosis


S Weir Mitchell and the Civil War

The Rest Cure

S Weir Mitchell, the enigma

Nerve doctors

Evolution and the brain

Chapter 4. Psychosomatic illness in the 20th Century

Freud, the early years

Breuer's famous patient, Bertha Pappenheim

Freud and Breuer's book on hysteria

Suppressed memories and childhood sexuality

Freud's model of the mind

Overall impact of psychoanalysis

Physicians, patients and psychosomatic symptoms

Common sense psychotherapy

Alternate medical treatments and suggestibility

War and Psychogenic Illness

PTSD the prototypical delayed stress disorder

Relationship between PTSD and mild traumatic brain injury (mTBI)

Psychosomatic medicine

Chapter 5. Biological mechanisms of Psychosomatic Symptoms

The biological link between stress and illness

The hypothalamic-sympathetic-adrenal axis

The brain's emotional center, the limbic system

The hypothalamic-pituitary-adrenal axis

Pavlov and neural plasticity

Hebb's Synapse

Molecular mechanisms of brain plasticity

Stress and the limbic system

Nerve growth factors and stress

The amygdala-prefrontal cortex connection

Central sensitization, a model of neuroplasticity

The descending pain modulatory system (DPMS)

Brain neurotransmitters

Gamma aminobutyric acid (GABA)





Stress and human behavior

Operant conditioning and behavioral therapy

Chapter 6. Psychosocial mechanisms of psychosomatic Symptoms

How can beliefs and expectations change brain function?

Doctor patient relationship and psychosomatic symptoms

The power of the placebo

Placebo's evil twin, nocebo

Statins and muscle pain and weakness

Glutens and Celiac disease

Expectations and beliefs

Hyperventilation syndrome

Idiopathic environmental intolerance and the nocebo effect

The Belgium Coca-Cola fiasco

Electromagnetic hypersensitivity

Infrasound sensitivity

Sick building syndrome

Summary of Idiopathic environmental intolerance mechanisms

Chapter 7. Low back pain, abdominal pain and headache

Overview of common pain syndromes

Low back pain

Historical perspective

Current approach to chronic low back pain

Physical activity and expectation

Depression and fear avoidance

Abdominal pain

Autonomic nervous system and the gut

Irritable bowel syndrome (IBS)

Peptic ulcer disease

Primary headache disorders

Migraine as a model for psychophysiological illnesses

Historical perspective

Migraine Auras

Early ideas on the cause of migraine

Mechanism of the migraine aura

Genetic susceptibility to migraine

Chapter 8. Fibromyalgia/Chronic Fatigue Syndrome

Pain but much more


Tender points

Central sensitization to pain

Repetitive strain injury (RSI)

Chronic fatigue

Epidemic and sporadic neuromyasthenia

Epstein-Barr virus (EBV)

Chronic fatigue immune dysfunction syndrome (CFIDS)

Myalgic encephalomyelitis (ME)

Overlap with depression and other psychogenic illnesses

Genetics of fibromyalgia and chronic fatigue syndrome

Chapter 9. Chronic dizziness

Anxiety and Dizziness

Near faint dizziness and fainting

Postural orthostatic tachycardia syndrome (POTS)

Dizziness and mass psychogenic illness

Persistent Postural Perceptual Dizziness (PPPD)

Migrainous dizziness

Post Concussion Dizziness

Sea legs and mal de Debarquement syndrome

Height vertigo and acrophobia

Chapter 10. Treatment of psychosomatic symptoms

Lifestyle changes

Exercise and the brain

Sleep and eating habits


Cognitive Behavioral Therapy

Internet Directed Therapy

Drug treatments

Drugs that increase brain monoamines (antidepressants)

Drugs that decrease excitatory (glutamate) transmission

Antiepileptic drugs

Anxiolytic drugs

Drugs that enhance neuroplasticity and neurogenesis

Ketamine, the new "wonder drug"

Drugs that effect endocannibinoid neurotransmission

Extracranial Brain stimulation

Electroconvulsive therapy (ECT)

Transcranial direct current stimulation (tDCS)

Transcranial magnetic stimulation (TMS)

Deep brain stimulation


Future Directions
Robert W. Baloh MD

Distinguished Professor of Neurology

David Geffen School of Medicine at UCLA

Los Angeles, CA