Subjective health complaints, sensitization, and sustained cognitive activation (stress)

https://doi.org/10.1016/S0022-3999(03)00629-9Get rights and content

Abstract

Introduction

This review argues that “subjective health complaints” is a better and neutral term for “unexplained medical symptoms.” The most common complaints are musculoskeletal pain, gastrointestinal complaints and “pseudoneurology” (tiredness, sleep problems, fatigue, and mood changes). These complaints are common in the general population, but for some these complaints reach a level that requires care and assistance.

Theoretical assumptions

We suggest that these complaints are based on sensations from what in most people are normal physiological processes. In some individuals these sensations become intolerable. In some cases it may signal somatic disease, in most cases not. Cases without somatic disease, or with minimal somatic findings, occur under diagnoses like burnout, epidemic fatigue, multiple chemical sensitivity, chronic musculoskeletal pain, chronic low back pain, chronic fatigue syndrome, and fibromyalgia. These complaints are particularly common in individuals with low coping and high levels of helplessness and hopelessness.

Conclusion

The psychobiological mechanisms for this is suggested to be sensitization in neural loops maintained by sustained attention and arousal.

Introduction

ICD 10 defines somatization as presentations of “symptoms” with persistent requests for examinations. Negative findings and reassurances that there is no physical basis for the complaints have little or no effect [1]. The most common complaints are muscle pain, “pseudoneurology” (DSM IV; tiredness, sleep problems, fatigue, and mood changes), and vague and unspecific gastrointestinal problems. These complaints are also very common in the general population. Most people do not seek medical assistance or advice for this, but for some such complaints are major concerns with a major impact on quality of life. Sudden onsets may signal serious somatic disease; usually, this is not the case.

In a recent survey of 1240 individuals from the Norwegian population 96% reported that they had experienced at least one type of complaint during the preceding 30 days. Musculoskeletal pain was reported by 80%, pseudoneurological complaints by 65%, and gastrointestinal problems by 60%. However, as expected in this normal population, when asked for substantial complaints the prevalence was moderate; only 13% reported substantial musculoskeletal complaints, 5% “pseudoneurological” complaints, and 4% gastrointestinal complaints [2]. A similar panorama of subjective complaints was found in a stratified sample of 4000 subjects, 1000 from each Nordic country (Denmark, Finland, Norway, and Sweden) [3], and in a large self-report investigation of 4000 Norwegian employees [4].

Most of us do not seek medical assistance for these complaints. However, the conditions are still the most frequent sources of long-term sickness compensation, permanent inability to work, and the most frequent reason for encounter and for repeated visits in general practice [3]. The medical establishment has never tackled these conditions satisfactorily. General medical examination, laboratory tests, and referrals to specialists do not reveal any pathological findings in most cases. General practitioners feel inadequate in their care of muscle pain patients [5]. The patients are dissatisfied with the care they receive [6] and seek assistance from nonprofessionals and a flourishing health market.

Section snippets

Symptoms or complaints?

These complaints are also referred to as “unexplained symptoms” [7]. We prefer the term complaints, avoiding the assumption of a disease that may lead the patient and the doctor astray. On the other hand, complaints are real phenomena for the patient. Pain is painful, fatigue is tiring, and a lousy mood is lousy. The term does not offer any diagnosis or clues to causality. It is, simply, a neutral, behavioristic statement—the individual is complaining.

The syndrome of muscle pain, fatigue, mood

Sensitization and its psychobiological basis

There seem to be no sharp lines between what is a completely normal phenomenon, ignored by most people, and crippling conditions that require support, treatment, and can lead to disability [2] (see Fig. 1). We suggest that these complaints are based on sensations from what usually are normal physiological processes. When, why, and in whom do these “normal” or common complaints turn into intolerable conditions?

We suggest that sensitization is the psychobiological mechanism explaining the

Cognitive bias, comorbidity, and sensitization to complaints

At the higher, cognitive level sensitization is remarkably similar to attentional bias or cognitive bias [17]. Brosschot [17] refers to this as cognitive emotional sensitization. There is evidence that anxious persons have a cognitive processing priority for information that is related to their fears (see Ref. [17]). Anxious persons will detect fear-related information earlier than other persons. Their normal cognitive performance is interrupted, and their cognitive capacity is absorbed in

Cognitive activation theory of stress

The literature on psychological stress seems to show a reasonable consensus on that the response and health consequences of stress depend on cognitive mechanisms [27], [34]. The challenge facing the individual is evaluated based on the expectancies attached to the situation and to the possible acts available to this particular individual. In other words, the resulting stress response depends on previous learning.

In a stress theory formulated in cognitive terms (cognitive activation theory of

Conclusion

Subjective health complaints are common—last month most of us have had one or more complaints. The severity and interference with our daily cores and quality of life varies. Some individuals are more sensitive than others. They are more likely to report many complaints at higher intensities. They have frequent visits to general practitioners and represent a major source of sickness compensation and permanent disabilities in industrialized countries. The high intensity of complaints reduces

Acknowledgements

The authors have been supported by the Norwegian Ministry of Health and Social Affairs and the Norwegian Research Council.

References (38)

  • RA Deyo

    Low back pain

    Sci Am

    (1998)
  • C Nimnuan et al.

    Medically unexplained symptoms: how often and why are they missed?

    QJM

    (2000)
  • E Shorter

    From paralysis to fatigue. A history of psychosomatic illness in the modern era

    (1992)
  • H Ursin et al.

    Sensitization, subjective health complaints, and sustained arousal

    The role of neural plasticity in chemical intolerance

    Ann N Y Acad Sci

    (2001)
  • S Wessely

    “Old wine in new bottles”: neurasthenia and “ME”

    Psychol Med

    (1990)
  • Diagnostic and statistical manual of mental disorders

    (1994)
  • TVO Bliss et al.

    Long-lasting potentiation of synaptic transmission in the dentate area of the anesthetized rabbit following stimulation of perforant path

    J Physiol

    (1973)
  • LJ Rygh et al.

    Cellular memory in spinal nociceptive circuitry

    Scand J Psychol

    (2002)
  • V Castellucci et al.

    Presynaptic facilitation as a mechanism for behavioral sensitization in Aplysia

    Science

    (1976)
  • Cited by (199)

    • Mechanisms underlying nontoxic indoor air health problems: A review

      2020, International Journal of Hygiene and Environmental Health
    • An Exploration of the Influence of Non-Biomechanical Factors on Lifting-Related LBP

      2023, International Journal of Environmental Research and Public Health
    View all citing articles on Scopus
    View full text