BERKELEY, CA (UroToday.com) - The introduction of this fascinating exploratory study of almost 1000 internal medical, neurological, and primary care patients states the following: "Medically unexplained or functional somatic symptoms are complaints defying the clinical picture of known, verifiable, conventionally defined diseases and unbacked by clinical or paraclinical findings.

In this study, the 978 patients consecutively admitted from a neurological department, a medical department, and from one primary care were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument (SCAN). Patients complained of a median of 5 functional somatic symptoms. No single symptoms stood out as distinctive for patients with multiple symptoms. Principal component factor analysis identified a cardiopulmonary including autonomic, a musculoskeletal, and a gastrointestinal symptom group explaining 36.9% of the variance. Latent class analysis showed that the symptom groups are likely to materialize in the same patients, suggesting that they are different manifestations of a common latent phenomenon.

Latent class analysis using inclusion of a group of 5 additional general unspecific symptoms allowed construction of clinical diagnostic criteria for "bodily distress disorder." Patients were divided into nonbodily distress (589), modest bodily distress (329) and severe bodily distress (60). The latter categories had a prevalence of 25% and 3% respectively.

The authors believe their data supports previous findings that the existence of specific functional somatic syndromes is an artifact of medical specialization. They identified a general, distinct, bodily distress syndrome or disorder encompassing the various functional syndromes advanced by medical specialties as well as somatization disorder and related diagnoses of the psychiatric classification. The syndrome can manifest as gastrointestinal, cardiopulmonary, or musculoskeletal problems.

While in no way referring to painful bladder/interstitial cystitis, the authors have taken a novel way of looking at a variety of syndromes often seen to accompany PBS/IC. Many are looking for a new paradigm within which to place the myriad of symptoms and problems associated with painful bladder patients, and this is seemingly a start.

Per Fink, Tomas Toft, Morten Steen Hansen, Eva Ørnbøl, and Frede Olesen

Psychosomatic Medicine, 69(1):30-39, 2007

UroToday.com Painful Bladder Syndrome Section

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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