Medically Unexplained Symptoms and RLS

Someone close to me told me that he had bought a book about MUS. In Dutch this is called SOLK. I didn’t know exactly what that was then. It was also quite new to him. His haptonomy therapist had advised him to read more about it. MUS (or SOLK) has to do with physical complaints for which no real cause is found. For the person dealing with it, these are of course very real complaints. However, a doctor cannot easily make a diagnosis, let alone treat the complaints with a specific medication.

I immediately found it an interesting subject and wanted to read the book too. It seemed interesting to me to see if restless legs might be a kind of MUS. After all, doctors often find it quite difficult to accurately identify restless legs. The symptoms of RLS are also not always taken seriously enough.

Sometimes a doctor may even go so far as to suggest that it is “in the head”. Personally, I think that’s a strange approach. Even if a physical complaint should “only” arise from mental problems (such as stress), then I think you should take it just as seriously. After all, it is no less real for the person dealing with it.

If you’ve read more of my blogs, you know my approach a bit by now. In line with this, I will address the following questions in this blog:

1. What is MUS (or SOLK)?
2. Are restless legs a form of MUS?

What is MUS (or SOLK)

MUS stands for Medically Unexplained Symptoms. This concerns physical complaints for which no medical cause has been found. The symptoms last longer than a few weeks, do not go away on their own and often even get worse over time. In some people the complaints spread to more parts of the body. Other names for MUS (or SOLK) are functional complaints, persistent physical complaints, psychosomatic complaints or physically misunderstood complaints.

There seems to be a link between MUS and stress. There is an interaction between mental stress and physical complaints. It is not always clear whether there was a physical complaint or mental stress first. In any case, the interaction results in a kind of vicious circle. The stress causes (extra) physical complaints and the physical complaints cause even greater stress. The system becomes over-stimulated. The increased sensitivity to stimuli that arises in this process is called central sensitization.

A frustrating situation arises for those with such complaints. No cause is found by doctors and specialists. Sometimes a physical cause is found, but it is unclear why the pain is so severe or continues for so long. The person in question has complaints for which there seems to be no solution. The consequences for daily life are major, because he or she feels much less capable than before. MUS (or SOLK) is common. No cause is found in just under half of the patients, either at the GP or among medical specialists.

Psychosomatic

Naming complaints is often the first step towards a solution. Medical recognition of unexplained complaints helps someone in the sense that he or she does not make up the complaints. It’s bad enough that you are not feeling well for a long time. You also have to fight against the idea that what you have “does not exist”. I think the value of acknowledging complaints cannot be overestimated.

A combined approach to physical and mental complaints seems to work best for MUS. This is about restoring an imbalance. The mind has become over-stimulated for a long time. The body has entered a situation of chronic pain. Body and mind both deserve extra attention and aids to recover and to avoid ending up in such a situation again.

With the physical approach you can think of relaxation exercises, mindfulness and yoga. From a mental point of view there are possibilities such as talk therapy and cognitive behavioral therapy. With the help of this someone gets more control over their own life.

Examples of MUS

There are several conditions that fall under the heading of MUS. Someone can have several at the same time. Examples of MUS are:

• Tension headache
• Concentration and memory problems
• Persistent fatigue
• Sleep problems
• Joint pain
• Tension complaints in neck and back
• Fibromyalgia
• Abdominal complaints (such as Irritable Bowel Syndrome or Premenstrual Syndrome)
• Pressure on the chest, palpitations and tightness
• Dizziness and balance problems
• Reduced immunity

To diagnose MUS (or SOLK), a doctor first performs a physical exam to rule out physical causes. After that, the complaint is evaluated on the basis of five dimensions. The five dimensions are: somatic, cognitive, emotional, behavior and social. Based on the outcome, a treatment plan is drawn up.

For example, there may be a genetic vulnerability or a vulnerability due to circumstances at home in the present or past. Someone may already be physically dealing with another illness and therefore less resilient. A major event such as surgery or burnout can also trigger MUS. Once there is MUS, it is often a combination of factors that keep the complaints going. Anxiety about persistent complaints (stress, anxiety, depression) and loss of condition play a role in this, among other things.

RLS and MUS

RLS is not mentioned in the list of examples of MUS. However, I do see clear similarities. Often no physical cause is found for restless legs. There is no cure for it and from experience I know that it matters a lot how you deal with your complaints. Not infrequently, restless legs are accompanied by stress, anxiety or depression, which in turn worsen the symptoms.

For RLS there are drugs that are prescribed by doctors in severe cases. Some of them are based on the action of dopamine. Others include opiates, hypnotics, and drugs for the treatment of epilepsy and nerve pain. However, these drugs only help to reduce symptoms. They do not cure.

Personally, I think MUS’s combined approach could also be very helpful for people with troubled legs. A combined approach of physical and mental factors may help to find a better balance in daily life. A strong reduction of the complaints does not seem impossible to me. It would be good if the medical world investigates the possibilities of this further.