YOUR HEALTH Dr James Le Fanu: 26 October
Thursday, 25 October 2012

Dr James Le Fanu: 26 October

How to treat ‘medically unexplained symptoms’, relief of coccyx pain and the tongue as an indicator of health…

Written by Dr James Le Fanu
Not so long ago, doctors, having failed to find some obvious physical cause for a complaint, would label a patient's symptoms as psychosomatic – implying that the problem was 'all in the mind'. Today, they prefer the terminology 'medically unexplained symptoms' (MUS), which carries the different connotation that there might be an explanation, but they just don't know what it is.

MUS accounts for between a third and half of those consulting cardiologists, neurologists and other specialists. This adds up to tens of thousands of people every year being referred from one clinic to another; for without a clear idea of what is amiss, it is difficult to offer effective treatment. It is thus bad news to have MUS, which raises the obvious question of what to do about it. First, it is helpful to become acquainted with the concept of a 'functional explanation' – illustrated by irritable bowel syndrome. Here, the most thorough of investigations for symptoms such as constipation or diarrhoea prove normal, so the problem lies, it is presumed, in the wave-like functioning of the bowel
muscles: contracting and relaxing to impel its contents forwards.

This failure to understand the complex mechanisms that underpin function, accounts for many forms of MUS – notably the aches and pains of fibromyalgia, some types of neck pain, menstrual problems and so on. It does not mean that there is a lot that can be done in terms of treatment but the notion of a functional disturbance provides a reassuring explanation. Many complaints do not fit into a recognisable pattern of illness. This may be because it is so rare that few doctors have encountered it or because it is an unusual manifestation of some recognised condition. This difficult situation has been helped by the internet where searching for the symptoms with key words can generate suggestions about diagnosis or treatment.

Finally, there is no harm in looking favourably on the possibility the problem may be compounded by the anxiety of not knowing what is going on. There is nothing to be lost from a 'trial' of antidepressants – just in case they make things better.

THIS WEEK'S MEDICAL PROBLEM comes courtesy of a lady from Surrey, troubled for the past 12 years with pain in the coccyx at the base of her spine. This was controlled by the anti-inflammatory drug ketoprofen until a couple of years ago it emerged this was causing kidney problems, so she now takes paracetamol with much less effect. 'The pain can be severe with no relief on standing or sitting,' she writes.

This pain in the coccyx, known as coccydynia, can follow an injury or may just 'happen'. It is usually advised for those in whom the pain is not controlled by conventional analgesics that they should have an injection of a combined local anaesthetic and steroid into the coccyx area. If that doesn't work, the other option is to have an operation to remove it. This sounds drastic but can bring blessed relief.

Tongue trouble

The tongue's appearance is believed to be a reliable indicator of health – if it's clear and shiny all is well, if dry and furred, not so. Traditional Chinese doctors interpret flabbiness as a sign of a gastric ulcer, paleness as due to hay fever, and a yellow coating as indicative of bowel problems. These distinctions are perhaps too subtle to be reliable, but at times the tongue may have a bizarre appearance as with 'black hairy tongue' where the sufferer has the sensation of the back of his palate being tickled.

'Hairiness' is due to the elongation of the cells at the back of the tongue, while the black colour is caused by pigment-forming bacteria. An effective treatment is scraping the surface of the tongue and increasing roughage in the diet.

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