Living with Persistent Physical Conditions

Persistent Physical Symptoms include fatigue, pain, weakness and bowel symptoms. They can be part of conditions such as fibromyalgia, irritable bowel syndrome and functional neurological disorders. These symptoms can be triggered by physical illnesses, like infections (for example post viral fatigue), after medical treatment like chemotherapy or be part of ongoing long term conditions, including long covid.

There may often be no cause found on medical tests and doctors sometimes call these “medically unexplained symptoms”.

• Persistent physical symptoms are extremely common - about 1 in 4 patients who see their GP have such symptoms. They can be even more frequent in some specialist clinics, for example 1 in 3 people in neurology or cardiology outpatients have physical symptoms with normal test results.
• These symptoms are absolutely real. They are not “in the mind”
• They can cause significant distress and can limit what people are able to do in everyday life, socially, at work and at home.
• Persistent physical symptoms can and do get better. Symptoms can get better with time without any specific treatment. But when symptoms are not going away, particularly when they are affecting our functioning, there is treatment and help available.

Persistent physical symptoms can include

• pains in the muscles or joints
• back pain
• headaches
• tiredness
• feeling faint
• heart palpitations
• stomach problems

They can be part of complex syndromes, such as:

• ME/ Chronic Fatigue Syndrome (CFS)
• Irritable Bowel Syndrome (IBS)
• Fibromyalgia
• Functional Neurological Disorder
• Long Covid

How is PPS treated?

The first step is a holistic assessment covering physical health, mental health, identifying exacerbating or maintaining factors and ensuring the diagnosis is right. It is essential to do this with you in a collaborative way.

Following this treatment takes a stepwise approach. For some people guided self help can be useful. Talking therapy is the most common next step. This is usually a type of therapy called cognitive behaviour therapy (CBT). It takes a practical approach and might include work similar to physical rehabilitation. It can also help identify and work on the links between thoughts, feelings and physical symptoms. There are often many factors involved in persistent physical symptoms. Some of these can be ‘maintaining factors’ which can keep the illness going or make the symptoms worse. Treatment is a process of identifying these and working with you to address them.

We may also suggest involving other health professionals you see, particularly where several specialists are involved. Medication can sometimes be helpful but is not usually the answer alone. Some types of medication, like long term use of pain medication, can actually be harmful without helping the symptoms.

Persistent Physical Symptoms Clinic at the SCC

We are delighted to introduce Dr Muj Husain, Consultant Psychiatrist, who is the Clinical Lead for PPS at the Sloane Court Clinic. Dr Husain studied medicine at the University of Cambridge and trained in psychiatry on the Maudsley Training Programme in South London. He is a graduate of the NHS Medical Director’s Clinical Fellow Scheme.

He is the consultant for the Maudsley Hospital’s National Persistent Physical Symptoms Unit which is also now a key part of King’s Health Partners’ treatment pathway for Long Covid. He also works in Liaison (mind and body) Psychiatry at King’s College Hospital. He is Associate Medical Director for National Specialist services at the Maudsley.

He has published peer-reviewed research on persistent physical symptoms and written scholarly educational articles for doctors and other health professionals. He regularly teaches these topics to audiences including other health professionals and students. He has given talks at the Royal College of Psychiatrists, the Royal College of Physicians and the Institute of Psychiatry, Psychology and Neuroscience (IoPPN).